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r 



Property of thi 

PUBLIC Library ofthb 
City of boston, 

tePeaiTEDIMTHS 




THE FRANCIS A. COUNTWAY LIBRARY OF MEDICINt 

BABVABD MII»CAL LOBARir-fiOflTON MEDICAf . LOttAKT 




ST. LOUIS 

MEDICAL AND SURGICAL 

JOURNAL. 



ISITBft BT 



M. L. LINTON, M.D. 






W. M. MoPHEBTERS, 


M.D. 










VOXiXTMHS XIX. 


r 
f 


C3. 






J-^- - 


ST. LOUIS, MO., 


rv- 
c 


f ■ 



6XOB6K KNAPP * CO., PBIXTRKS AND 9INDKRR. 

1861. 



:> j^f^ 



i^ 



/ /' 



-/ , , -"*-:' ' 



INDEX. 



"ST o I- TJ atf aa 



AafcoItAtloii and Pavemiioii, llaiwAl of^— ••» 64 

AratGelii 79 

Anamia from prolonged Lactation ^.«.......... 84 

Atlaa on Animal Histology ^................ 149 

Anatomy, Leidy's 338 

Action of dlirorentMedicinM on Mental Facnltiea 987 

Add, Hydrochloric, in Chronic Dyipepsia 8fi8 

Ahortion and Frematue Labor •« 981 

Abortion, Case of. ^ 411 

Abienoe of Vagina ^..^— .^ 440 

Abainthe Drinking in France 448 

Afthma, Pathology of. 5«8 

Anatomy, Lamentable Ignorance of. ,. 4B$ 

Add Carbonic, Piopertief of. S06 

Anthrax followed by (Edematous Laryngitis and Death 487 

B 

Bladder, Rnptnre of. Case, &c 10 

Blighted FoBtos, carried to ftill Term 97 

Billingslea, Dr., Death of 4T7 

Biningalea, Dr., Memoir on 481 

Belladonna Shortening Labor 448 

BatUeof Bnn Bun 548 

c 

CronpwithontCnrapy Symptoms 64 

Chlorofbrm, New application of, in Kenralgia »*»^ 72 

Chlorate of Potassain Gonorrhoea ^ 191 

Cannabis Indicaasa Hypnotic 973 

Cold Water, Value and use of. ...• ^ - 967 

Chlorate of Potash 374 



IV IITDBZ— YOLUUS XIX. 

Pug*. 

Cbloioform in OongastiTe Chillf 374 

Chancre, Lectures on, by Dr. Hammond. 422, S29 

Offtorrhcea ti. Matrlmonj 441 

Cataneoui DiBeafet, Bemediet fbr 442 

Chlorate of Potash as a Prophylactic 458 

Cow Pox, New Experiments on 460 

Chloride of Zinc in Diseases of theBUn 504 

Corps of Medical Cadets ^ - 566 



D 

Diphtheria, Cases of, bj 8. T. Newman, 1C.D 1 

Digestion, Physiology of. 86 

Diphtheria, Ravages of. 101 

Diphtheria, Beport on, by Dr.Kennard v**—*- 120 

Diphtheria, Treatise on 144 

Diphtheria, Core of Cataneoos, by Perchloride of Iron 148 

Daague, Epidemic of. 157 

Digitalis in Mania^i^ota 161 

dysentery, Epidemic 165 

Diphtheria, Local Treatment of. 170 

Diseases of Printers... .•>. 181 

Diabetes, New Test of. 182 

Diphtheria, Belladonna bt its Treatment. 205 

Diphtheria, Treatise on 208 

Dysentery, Epidemic, Remarks on 229 

Diphtheria, Artlcleson 240, 434. 483 

Detachment of Placenta^ post partem, New elgn of 461 

Dfseases of Children, Leetmrason 513 

Dover's Powder in Penpiratlon of Phthisi*. * 538 

E 

Editorials 90, 183, 270, 379, 477, 565 

Ergot of Rye in Diseases of Bladder 150 

Ear, Gouty Concretions of. 169, 433 

Extraordinary Case , 172 

Erticaria, as a Symptom of Irritation of Sexual Organs 179 

Ergot, Therapeutic yalue of 260 

Eochymosis, Convallarius in 433 

EmboUa in the Arteries of the Extremities 502 

Eczema, Treatment of. 553 

F 

Foreign Correspondence— Dr. Cooley ..- 15, 108 

Foreign Correspondenoe-Dr. PoUak 108, loa, 306 

Plater Nail Signs..,....., 167 

Fever, Treatise on 336 

Feifoson, Dr., D^ath of. 370 



uf Dsx— yotLsaa zoc* r 

G 

QniOxj^Ur^ Death of. •.•..•^..^„ 480 

GoBorrinBa» PenalphUeof Iron la ^ fltf 

H 

Hemoirhoidi, Treatment of.. 88 

Hospital-Pnctioe, Hand Book of. 147 

Hoi optiogB of Arksmas... ••• • 108 

HemoRliaKeof theBoweb in CiiildrBn 174 

HemonrboidSfTreattaeon 365 

Hnmeio-Ufaiaar Joint, Operation, 4bc.-^Pr. Ck>oper. 414 

Hsmatldrosii (Bloody Sweat) .....^ 451 

Hemp, Indian:— its Piopertiee of Prodndnff Sleep 406 

I 

Iodide of Chloride of Mereniy in sun Diaeeae 70 

Imperforate Anna, Oaaeof^ 235 

Intermittent Ferer, Nitrate efPolarii in 334 

InflneneeofMother'allindonFcetnainUtero 434 

InftntAlimentiitlon. 408 

Iodine Inhalationa in Phthiaia 537 

InrertionofUtemafGaaeof. 50 

Innnitr, Pnerperal 498 



Keroaolene, Experfanentawitfa; 474 

L 

LencocyihoBmiA, Caae of. 250 

Laryncoaeope « 375 

Laeinc, Tight 405 

M 

Medical Society, St. Lonia, Report of Proeeedlnga of... 17, 914, 380 

Monatroaity, Caae of , 288 

Malformation of Beotun, Treatlaeon 230 

Mormonlam in itaPbyaieal and Moral AapeeU 270 

Medical Miflcellany 02. 1»7, 283, 381, 480, 970 

Military Surgery 315 

MldwiforTf Remarka on 558 

Medical aaaa in St. Lonia ^ 507 

Morement Care, Theory and Practice of 480' 



Vi INBBX— VOLUIOE XIX. 

N 

Fog*. 

NMmlgia, Treatment of • 263 

Neoralgia, Facie], Memoir on 289» 365 

NenroQB Irritation, Effects of Reflex 506 



Ovarian Tumor, Death from 13 

Oxalate of Gerinm, Therapeutical ose of 153 

Oeieonf Anchylosis of Knee-Joint 811 

Ossification of the Muscles 447 

Oxide oi Zinc, Therapeutic Employment of..- 526 



Patholoinr, Some Points in, &c 6 

Physiology and Pathology^Beportof Ck>mmittee 36 

Practice of Medicine, Churchill's Beyiew 63 

Phthisis Pnlmonalis, Piq»er on 130 

Piixe Essay, Beriew of. 142 

Periodicity as a Character of Disease 176 

Physiology, Dalton's - .... 239 

Prostatorrhoea, Treatise on 273 

PosCoipnscIesin the Air 376 

Phthisis Pnlmonalis— Curtis on 390 

Practice of Medicine— Maxson on 420 

Philosophy of Stinks 454 

Puerperal FeTer,Kature and Treatment of. 547 

Pfegnan(7, Morning Sickness of. 501 

Placenta, Management of. 561 

Poison of Rattle Snake, Antidote 536 

Q 

Quinine as a Prophylacdc^.. 49^ 

Quinine as a Prophylactic in Malarious regions 506 

R 

RaieCase, Child bom covered with Sulphur. 102 

Registration Beport 143 

Radius and Ulnar Degeneration of. Removal, &c 416 

Remarkable Surgical Case ~ 459 

Right Man for the right place 466 

Reetoratienof Suspended Animation 528 

Renunciation of Homoeopathy 528 

Rigidity of the Os Uteri 503 

Ryland, Dr., Death ot 569 



INDEX— VOLTTUX XII. TU 

s 

SmithAoniaa Inftitntion •• 367 

Ssnitary Gonditioii of Troops ^^ yjs 

StonuUitlfl MftternA » 419 

San-Stioke. « 466 

fijingilniiria Cuudensis 546 

Scarlet Fever and iti Treatment 554 

Stimnlanti aa a Beyerage 555 

Sjrpliillflation, Theory of 65 

Scarlatina Albnminaria 540 

Bitk and Wounded Soldiers in St. Lonis 567 



Taming, Article on - 69 

Ther^pentics, Rational Principles of. 75 

Tdbacco, Use and Abuse of. 81 

Typhoid Fever, Quinine and Veratria in 149 

Tape-Worm, Aromatic Sulph. Add in 152 

Traumatic Tetanus, Treatment of 171 

Tumors, Classification, Diagnosis, Ac., of- 241, 337 

Tape- Worm, Remedies for, in Abyssinia 538 

U 

Uva UrsI, in slow Labor. 160 

Uremia ^ 260 



THE ST. LOUIS 

MEDICAL MD STJEGICAL JOUEML. 

Vol. XIX. JANUARY, 1861. No. 1- 

PART I. — ORIGINAL COMMUNICATIONS. 

ARTICLE I. 

Report of several cases of Diphtheria. By S. T. Newman, 
M.D., of St. Louis. 

In the latter part of September, a family, consisting of a gen- 
tleman, his wife, and two children, visited our city, for the pur- 
pose of attending our State Fair. Soon after their arrival, the 
wife was attacked with sore throat, and I was requested to see 
her. The husband stated to me, on the way, that he felt serious 
misgivings about the character of the disease, as they were from 
Kentucky, where diphtheria had been, and was still prevailing in 
a very malignant form. Upon examining the throat, I discover- 
ed indications of a grave and ominous character : nearly the whole 
of the lateral aspect of the throat (involving both sides) was cov- 
ered with dirty whitish patches, under which there was a tendency 
to ulceration of a superficial character ; the entire periphery was 
inflamed : the tonsils were somewhat swollen and deglutition was 
painful ; the neck was also slightly swollen on the outside. The 
general symptoms were anorexia, constipated bowels, coated 
tongue, quick pulse, with cool skin. Though these symptoms 
were grave enough, the uneasiness which I felt was caused more 
by the alarming accounts which I had heard of the disease in 
Vol. XIX — 1 i 



2 On Diphtheria. 

Keatucky, than on account of the severity of the symptoms them- 
selves. I at first applied to the diseased surface^ by means of a 
large camel's hair pencil, a strong solution of nitrate of silver, 
and directed the bowels to be opened. I then put her upon the 
following Bi — Chlorate potass, 3 iii ; acid hydro-chloric, 3 i ; 
sulph. quinin., 3i; aqua dist., ^ viii. M. Dose, a tablespoon- 
ful every two hours, or oftener. Visited the patient in the even- 
ing, symptoms unchanged. Again applied solution nitrate sil- 
ver ; prescription continued. On the following morning I regard- 
ed her condition as being more favorable. The pulse was however 
still frequent, numbering about 100. Treatment continued, with 
the addition of wine. From this period improvement continued, 
and the patient recovered. 

While in attendance upon the mother, one of her children, a 
little girl about four years old, was attacked with the same dis- 
ease. She was treated upon the same general principles, and re- 
covered. Tinct. fcrri muriat. was given to both during conva- 
lescence. There were no other cases in the family, or among 
the friends with whom they were stopping. 

While attending upon these cases, a gentleman living in Stod- 
dard Addition called on me, and desired me to sec a negro girl 
about eleven years old, who was laboring under sore throat, and 
seemed quite unwell. I learned also that some friends from a 
distance had been stopping with him, and that some of the chil- 
dren bad been affected with sore throat, from which they had not 
fully recovered when they arrived at his house. I visited this 
girl, first, Sept. 29th. Upon examining her throat, a very unfa- 
vorable condition was presented. Both sides of the throat were 
covered with a whitish exudation, under which there was consider- 
able ulceration ; there was also great surrounding inflammation 
with swelling of the tonsils, and of course difficulty in swallowing; 
articulation was hoarse and indistinct, and there was a very copi- 
ous flow of saliva, as if the patient were laboring under mercurial 
ptyalism ; pulse frequent and small ; the bowels were constipated, 
tongue coated, and there was no desire for food. I could not 
but regard the symptoms as being of a grave character. The 
throat was first penciled with the nitrate of silver in solution, and 
then put upon the mixture above, viz., chlorate potass, quinine, 
and muriatic acid, with the free use of wine. The bowels were 



On Diphtheria. 8 

kept soluble by means of ext. rhei ; and fluid diet^ consisting of 
milk and broths , was ordered. The next day there was bat little 
change in the general condition of the patient, except that there 
was yery great external swelling of the neck. The treatment was 
continued, with the addition of tinct. iodine externally applied. 
In the course of a day or two there was evident improvement ^oth 
in the general and local symptoms : the pulse was improved ; the 
external swelling had almost entirely disappeared, deglutition was 
effected with comparative ease, and articulation was more dis- 
tinct ; the patient slept and breathed comfortably ; the ulceration, 
though remaining, showed indications of healing. I now felt 
satisfied that the patient would recover ; but in a few days the 
ulceration began to deepen, with a tendency to sloughing, and in- 
volved not only the mucous membrane, but seemed to extend to 
the muscular tissue. Deglutition became very painful. The 
tinct. sesquichloride ferri was substituted in the mixture for the 
muriatic acid, and aqua chlorine was applied to the diseased sur- 
face by means of a probang, and a domestic gargle of a decoc- 
tion of sanguinaria, which had been suggested, was allowed. To 
counteract symptoms of prostration, quinine, wine and carbonate 
ammonia were ireely used. Swallowing soon became very diffi- 
cult, and the effort produced the most violent pain the ears, so as 
to cause the sufferer to place the hands to the ears and writhe in 
the most distressing manner. When the stimulants were regurgi- 
tated through the nose, an effort was made to rally the patient by 
the use of active stimulants per rectum, but without effect ; the 
pulse became more and more feeble, and for some time before 
death was no longer perceptible, and yet there was no dyspnoea, 
and the patient appeared conscious up to the hour of dissolution, 
which took place October 18th. 

While in attendance upon this case, the mistress began to com- 
plain of debility, with some irritation of the throat, which upon 
examination was found to be congested, but no ulcers were dis- 
cernible for five or six days. As the lady is an unusually ner- 
vous, timid woman, I thought that most of her disease was 
imaginary, or the result of nervous debility, and prescribed sugar- 
coated assafoetida pills, and occasionally the mixture chlorate 
potass, quinine, and muriatic acid ; but in five or six days, not- 
withstanding this treatment, several superficial ulcers were seen, 



4 On Diphikeria. 

covered with flocculent matter. In some places, where these lit- 
tle flakes wero removed, the epithelium remained nnbroken, in 
others there was abrasion of surface. The solution of nitrate 
silver was applied a few times ; the decoction sanguinaria was 
freely used as a gargle, and as the lady complained of debility 
wine was ordered, and the mixture containing quinine (as above) 
was taken more frequently. The appetite was good tliroughout, 
and nourishing diet was allowed. The patient recovered. 

During the pendency of this case, a negro boy, »t. about 17, 
(who had attended constantly upon the girl who had died,) was 
observed to be dull and drowsy, and complained of sore throat, 
which upon examination was found to be considerably inflamed 
aud swollen, but there was no ulceration or deposit of whitish 
flakes ; his pulse was frequent and small, though he was a boy 
of unusual physical vigor ; the tongue was coated, bowels consti- 
pated. He was put upon the mixture potass, and quinine, and 
was directed to use salt and water freely as a gargle ; he made 
use of the decoction sanguinaria also for the same purpose. No 
nitrate silver was used. The next day, or perhaps the third day, 
ulcers were discovered in the throat, with t^e characteristic cov- 
ering ; there was also great tumefaction of the tonsils, with diffi- 
cult deglutition, and excessive flow of saliva, and the boy wi^ 
evidently greatly worse. A solution of nitrate silver was freely 
used, and the former treatment persevered in. During the night 
the gentleman himself — who was the only remaining member of 
the family — feeling great uoeasiness in his throat, became alarm- 
ed, and while I was at the breakfast table next morning, his 
brother called on me with a note expressive of great concern and 
requesting me to bring Dr. Pope out with me. Upon our arrival 
we found the gentleman decidedly more scared than hurt. There 
was indeed no cause for alarm, and he was simply ordered to use 
the mixture as before mentioned, and no further medication was 
required. The negro boy's throat was much ulcerated, and Dr. 
Pope discovered some effusion of lymph. The treatment was ap- 
proved and continued. There was but little change in him for a 
day or two, except that the neck became swollen externally and 
the effort to swallow — as in the case of the negro girl — caused 
great pain in the ears. The outside of the neck was painted with 
tinct. iodine, Tvhich was directed to be applied occasionally until 



On Diphtheria* 5 

slight burning was produced ; and, upon yisiting him one mornings 
I was surprised to find the whole anterior and lateral portions of 
the neck blistered, and upon one side there was a large accumu- 
lation of serum, which was discharged by clipping. No incon- 
venience followed the blister, but the throat rapidly improved 
from that time ; improyement, however, was apparent before this 
period. 

While the lady was sick she was several times visited by the 
wife and sister-in^-law of Dr. Helms. The Doctor informs me 
they were both attacked with sore throat, both in a mild degree, 
but attended with unusual debility. In one case, for several 
days there was an exudation and a thin membranous deposit, 
which, when removed, left the mucous membrane unbroken, but 
again reappeared. 

It will be observed that the worst cases were confined to ne- 
groes, and that in both there was great tendency toward ulcera- 
tion and sloughing. Dr. Helms has suggested to me that this is 
more likely to be the case in the negro ; whether it be true or not, 
I am not prepared to say. 

Remarks. — ^Upon a resum^ of these oases, I would remark, 
if there were any striking peculiarities, they consisted in the very 
early symptoms of debility, and the excessive pain in the ears 
upon attempting to swallow, which last symptom was present in 
two cases. In the treatment there is noting new ; it is such as 
is recommended in some of the European journals, except per- 
haps the use of iodine externally — which was suggested upon 
general principles — and the sanguinaria as a gargle, which was a 
domestic remedy. And I would here remark, Messrs. Editors, 
that regarding this disease as having its origin in some materies 
morbi in the blood, and the disease of the throat being only a 
local manifestation, I do not place much reliance in topical appli- 
cations, and especially when applied with a probang, which I 
repudiate. Having heard that diphtheria was prevailing with great 
malignancy in Lexington, Ky., before having seen any of the 
above cases, I wrote to one of the physicians of that city inquir- 
ing if there were any peculiar characteristics of the disease in that 
locality, and how far it was amenable to treatment, and what 
plan of treatment appeared best adapted, &c. Omitting to fur- 
nish any information upon general principles, he writes with some 



6 Pathology and Practice of Medicine, 

degree of self- glorification — thongh not in the most classic or 
Addisonian style — as follows, as to his treatment : 

Lexington, Sept. 29th, 1860. 

Dr. S. T. JVitoman — Dear Sir: I received your letter a 
few days since, requesting my mode of treating diphtheria. In 
reply I would say, I give the muriate of ammonia in full doses, 
say, to a child eight years old and upwards, 10 grs. every two 
hours (in solution), and ten drops of the sesquichloride of iron 
in the intermediate hours ; and these are not to be omitted for 
thirty- six hours; then rest four or five hours, and give them 
again in like manner. Continue this treatment for four or five 
days according to circumstances ; but at first cleanse the stomach 
with a gentle purgative ; afterwards, if the bowels should not 
act, once in twenty-four hours give castor oil and ol. terebinth, 
^ i of the former to 3 i of the latter. If the diphtheric crest 
forms or has formed to a great extent in the throat, remove it 
with a fine sponge tied on a stick ; the sponge should be wet with 
a solution of the pure nitrate of silver 40 grs. to I i, or the sul- 
phas cupri 3 i to I i of water ; this should be used only once a 
day. The cure should be completed by the use of tonics ; I have 
found beeberine the best. Diet nourishing. 

I have treated three hundred and thirty- four cases after this 
method without the loss of one, and am now fully satisfied it is 
the proper mode of treating the disease. 

Respectfully yours, &c., 

J. W. Bright. 

Since the receipt of the above letter, I have been shown a letter 
from a very intelligent merchant of that city, stating that the 
treatment of Dr. Bright has been eminently successful, and that 
he believes it will save ninety-nine out of a hundred, if not the 
whole. 



ARTICLE II. 

Some Points in the Pathology and Practice of Medicine. 

[The following letter on certain points in the *< Pathology and 
Practice of Medicine'* was written by Dr. Chas. L. Carter, of 



Pathology and Prctctice of Medicine. 7 

Johnson Gonnty, Mo., to his ancle Dr. L. Garter of Eentncky, 
and by the latter sent to us for publication. It is worthy of be- 
ing read. — Ed.] 

Esteemed Uncle : — ^Yours of the 26th ultimo came to hand 
four days after date, laden as usual with much that is interesting. 
So the mercury question is decided and we will dispense with it. 
Believe me sincerely gratified to learn that you are averse to 
ptyalism as a remedial agent. I use calomel or mercury in some 
form in the major part of cases that come under my care ; but I 
use precaution to avoid " touching the gumSj^^ as that effect 
evinces that the mercurial treatment has been pushed too far, and 
the vital tissues are giving way under its toxical influence. 

The lancet is but seldom used in this country, except by a few 
physicians in my acquaintance, who were educated in the Ken- 
tucky schools. 

Tou are less benighted with fogyism than most physicians of 
your age. I am, and have, during my short professional life, 
been an industrious and scrupulous investigator of the workings 
of the organism in health and in disease ; and with the light which 
my investigations have afforded me I can see error depicted on 
the pages of many of our standard works, even of recent origin. 

Our profession has been called the most learned profession 
known to man ; and so it doubtless is : I am sure it comprises 
the greatest body of the most learned men on earth. . But I must 
confess it is repugnant to my feelings to take a retrospect of the 
deplorable doctrines and destructive practices of the darker ages 
of our profession. 

The ruthless car of empiricism, as a besom of destruction, swept 
over the land, consigning the hale to valetudinarianism, and the 
really afflicted as oblations to the common mausoleum of* former 
generations. But a brighter day has dawned. Investigations 
having been directed in the right channel {id estj to physiology, 
pathology and chemistry), nature unfolded the mystic woof, and 
shed a halo of light around her successful votaries. 

Although much yet remains in the form of hypothesis to be 
verified by careful and continued research — and more perhaps to 
be dreamed of — ^yet we are encouraged to see the mist of puerile 
conjecture give way before the light of reason, as the fog recedes 



/ 



8 Pathology and Practice of Medicine. 

from the light of the blazing Bun. I revere those sealoaB-hearted 
and clear-headed votaries to the truths of nature's abstruse laws, 
whether of the present generation or of days of yore, whose re- 
searches have contributed to expand the domain of pathology. 
Chemistry has rendered material aid to the rational practice of 
medicine, particularly in those forms of disease which are to be 
encountered and conquered by the action of direct specific anti- 
dotes. 

If, while following blind empiricism for six thousand years, 
chance discovered the remedial virtues of some of our most valued 
drugs, then we are by an easy transition of thought led to con- 
clude that those great results of popular observation will be more 
than equalled each year by the positive and veritable results of 
rational pathology. Think for a moment of the highly utilita- 
rian extent to which pathology has already been carried — of the 
irrational diagnosis and injurious treatment which are every day 
giving way under its auspices. Think back a few years, and 
see how many died of the lancet ; of mercury ; of antimony. 
How many have died for want of a sufficiency of cold water 
to attenuate their blood, and to wash out the materies morbi 
by the emunctories ; and, agaid, how many have died mainly of 
inanition. All died of the rashness and intolerance of their 
misguided advisers. 

Look at the limited knowledge physicians possessed of the 
essential character of disease. You have seen them calling 
^ symptoms disease, and treating them alike irrationally, till the 
patient died of the disease and the treatment — or got well in 
spite of both of them. You have seen the profession bleed, 
blister and purge their patients for endo-carditis ; thus com- 
promising the conservative powers of nature — all with extremely 
doubtful propriety, as dilatation of the nutrient vessels supply- 
ing a part is an essential precedent to the existence of inflam- 
mation; and as the membrane lining the heart has no vassa 
vassorumy it is not clear that such disease could exist, the 
valvular murmur being induced by deposites of fibrin on the 
valves of the heart. The vegetation found on the valves are 
very evidently mere deposites of fibrin from the circulating arte- 
rial blood, and not the product of inflammation. See them 
bleedinj; their patients repeatedly and copiously, to destroy the 



Pathology and Practice of Medicine. 9 

fibrin ; but the more thej bleed, the greater the proportion of fibrin 
left in the system. Bee them bleeding pregnant women for neu- 
ralgic pains, or merely because they were incincia. And the 
*' neighborhood bleeder'' had to bleed every big -bellied woman 
in his vicinity ; and the doctors looked wise^ and nodded assent. 
See them treating typhoid fever and scarlatina, mainly, with 
mercury — collapsing their pneumonic patients with tartrate of 
antimony — ^making patients ran the gauntlet of ptyalism, thus 
adding much to the sufferings and hazard of the patient, just 
because their empiricism told them it was right. But I need not 
dwell longer upon errors which pathology renders obvious to us. 

Among the positive teachings of pathology, we find the ac- 
coucher's eclampsia often depending upon retained urea; the 
autumnal fevers, on retained hydro-carbons; cancer, on living 
germs deposited from the blood ; rheumatism, on a redundnncy 
of uric and lithic acid in the system ; stomatitis materna, on 
inflammation or ulceration in the os uteri or vagina — sometimes 
in the bowels. Psoas abscess is now known to be as indicative 
of the strumous diathesis as is phthisis pulmonalis. But I can 
not couch the manifold utilitarian revelations of pathology in a 
few pages of cap paper, or even hint at all its instructive jbear- 
ings in the rational diagnosis and treatment of disease. 

This science having shorn our profession of so many destruc- 
tive evils, and having contributed so much to establish the prac- 
tice on a rational basis, in but little more than a quarter of a 
century, we may a priori expect to be delighted and instruc- 
ted at every step of our progress, as we solve the abstruse prob- 
lems of this hitherto sealed book of nature. At every turn of 
the subject, and in every fresh illustration which it reveals to us, 
we derive more steadfast conviction of the total absence of chance 
or irregularity, even in the strangest influences of disease ; we 
become habitual observers of that mystery which tends to pre- 
eminently enlighten and to elevate the mind — observers of the 
immutable uniformity which prevails in the observations of na- 
ture's laws ! Who would wonder if ere long the whole secret and 
character of the most obstinate diatheses will be understood — and 
cancer, phthisis and epilepsy yield as readily to treatment, as do 
now remittents and urticaria ? Things not less marvellous have 



10 Case of Rupture of the Bladder. 

already come to pass ; and so it may be that yoa and I will 
both witness this triumph in our profession. 

Every intelligent physician will readily agree that a man is a 
physician just in proportion as he is a pathologist. It is well 
known that almost the entiro amount of valuable information we 
have of the healing art is derived from the professional sciences, 
and not from blind empiricism. It is known, that, to an unedu- 
cated observer, the abnormal workings of a diseased organism is 
inexplicable and uninstruciive ; nor indeed can it be otherwise, 
as philosophers are not made by mere intuition, nor astronomers 
by viewing the heavens with the natural eye. Those who would 
get experience in medicine must first get medical science and 
common sense, as these are absolutely indispensable requisites 
to the acquisition of experience. 

^ Yours in consanguinity and in Medicine. 



ARTICLE III. 



Case of Rupture of the Bladder — Death Resulting on the 
third day—Jiutopsy. By E. P. Toney, M.D., of St. 
LotiiSj Mo. 

Michael Powell, aged thirty years, gardener for Gapt. Eads, in 
the western suburbs of this city, whilst on a somnambulic adven- 
ture, during the night of July 17th, fell from a second story win- 
dow, a distance of some fifteen feet, to the ground ; whence he 
was conveyed (in an almost insensible condition) by Gapt. Eads 
to comfortable quarters. Saw him on the morning of the 18th, 
at 8 o'clock. Lies on his back ; countenance pale and anxious ; 
pulse sixty, weak and small ; extremities cold ; complains of pain 
and soreness over the region of the bladder, which is tender to 
the touch. After prescribing ( ?; — Acet. morphia, grs. ij ; carb. 
of ammonia, 3 i; camph. julep, 1 iij. — M. A tablespoonful to 
be taken every hour, with hot hop fomentations over the painful 
region,) I left him, to see him at one o'clock, P. M. 

At this time, I find him feeling better ; countenance much im- 
proved ; pulse eighty and full, but still complains of pain over 
the region of the bladder, with constant disposition to pass water, 
but has only passed a few drops. Passed catheter into the blad- 



Case of Rupture of the Bladder. 11 

der without difficalty, and drew off about two ounces clear urine, 
which towards the last was tinged with blood. Continue treat- 
ment with the addition of ten drops tinct. of arnica to each dose 
of the mixture. 

6 o'clock, p. M., same day, find my patient very restless, pain 
and tenderness becoming generally diffused over the abdomen, 
with considerable tympanitis ; constant efforts at micturition, 
urine passing by a few drops at a time, and only in a standing 
position. 

Believing from the symptoms present -that eztensiye general 
peritonitis was threatened, and the pulse being about 100, strong 
and wiery, I placed the patient in an upright posture and opened 
a vein in the arm ; but finding the pulse to sink under the loss of 
blood, I discontinued the venesection after about eight ounces 
were drawn, and prescribed ^ — Calomel, grs. xx ; gum opii, grs. 
X. M. ft. pil. 1^0. vi. One to be given every two hours. Con* 
tinue the hop fomentations over abdomen. 

At 10} o'clock, p. M., saw the patient in company with Dr. 
Annan. Pulse 90 ; all other symptoms becoming more aggra- 
vated ; efforts at micturition constant, and the pain attending it 
agonizing; urine passes guttatzm, and only when the patient 
stands. Made an ineffectual attempt to pass a gum catheter, but 
succeeded with a larger sized silver instrument — a good deal of 
resistance about the neck oE the bladder. Some two or throe 
ounces of urine, tinged slightly with blood and mucus, passed. 
Directed calomel and opium pills to be given more frequently, 
and continue fomentations. 

I9th. Patient rested and slept some little, but is now again 
very restless — pulse 100 and weak; pain, tenderness and tym- 
panitis increasing, with a constantly increasing desire to pass 
urine. Continue treatment, with the application of twenty leeches 
over lower portion of abdomen. From this time during the next 
twenty-four hours, saw the patient once or twice in company 
with Dr. Annan, and once with Professor Charles W. Stevens — 
symptoms, as above stated, constantly increasing, and poor 
Michael's sufferings frightfully agonizing. We mutually con- 
cluded that nothing could be done, save to soothe and palliate his 
dying moments by the free administration of opiates, which was 
done. Died on the 2l8t, at 2 o'clock, p. M. 



12 Case qf Rupture of the Bladder j trc. 

At 6 o'clock, same evening, myself and Dr. Annan being 
present, Prof. Steyens, at my reqaest, proceeded to make post 
mortem^ by incision along the linea alba to the symphysis pubes. 
Upon dividing the tissues above and behind the symphysisi a 
contused and lacerated condition of the muscles and cellular tis- 
sue of the parts was made apparent — a quantity of fluid mixed 
with blood escaped, which was recognized as the contents of the 
bladder, &c., from its strong urinous smell. Continuing the in- 
cision into the cavity of the abdomen, we found the bowels enor- 
mously distended with gas, and perhaps a quart of serum in and 
about the pelvic cavity ; the inflammation seemed to have been 
confined to the pelvis and its immediate vicinity. No evidence 
of urine in the abdominal cavity. Opening the bladder at its su- 
perior portion, and continuing the incision anteriorly, we found 
the point of rupture, a small lacerated opening, just above the 
neck, through which the urine esc.aped into the surrounding cellu- 
lar tissue of the parts, and external to the peritoneal sack. 

Bemarks. — ^It is to be regretted that our post mortem in this 
case was necessarily imperfect, in consequence of the arrival of a 
friend of deceased, who quarrelled and violently opposed the 
whole proceeding. Enough was elicited, however, to account for 
the patient's great suffering and death. 

This was evidently an obscure case, and well calculated to 
mislead even veterans in the profession, so far as the diagnosis 
was concerned. First — ^because there was no well-marked symp- 
tom of rupture of the bladder, but enough to indicate extensive 
and general peritoneal inflammation; the pain and tenderness 
was not confined to the region of the bladder, but was intensely 
acute over the entire abdominal parieties. And, lastly, because 
it rarely happens that a patient who has rupture of the urinary 
bladder is unceasingly annoyed with desire to pass his urine ; 
which, notwithstanding the laceration in this instance, continued 
frequently to pass in small quantities. 



Jlges of Pregnant Women. — Dr. Granville, in some extensive 
statistics presented to the London Obstetrical Society, states that 
English women arrive at the culminating period of prolifligacy at 
the age of thirty years, and French women at twenty -eight. 



Ovarian Tumor. 13 

/ ARTICLE IV. 

Ovarian Tumor-^Deathj and Post -mortem Examinaiimu 

[The following case of ovarian tumor is taken from a letter to 
one of the editors of this journal, from Dr. J. G. Womack of 
Jackson, Tenn.] 

A negro girl of mine, aged 16, was safely deliyered of a living 
child on the 10th of September last. I arrived at my plantation 
about ten minutes after the birth of the child, and found the pla- 
centa lying loose in the vagina, which was taken away without any 
hemorrhage. My attention was then called to the condition of 
her abdomen, which was much swollen, with no marks clearly de- 
fined except in the lower portion, which seemed hard and unre- 
sisting. She complained of no pain, and I concluded, as I could 
not then form any diagnosis that was satisfactory to my mind, to 
let her rest. On the next day, finding the same condition of things, 
I prescribed castor oil with a teaspoonful of turpentine, thinking it 
was perhaps a case of tympanitis. The medicine operated well, 
with no change. 1 then requested my friend and relative Dr. 
Dashiell to visit her with me, which was done. Five days after 
delivery, he made a careful and thorough examination, and came 
to the conclusion, emphatically, that there was another child, and 
that he felt distinct motions, though he was unable to detect the 
click of the foetal heart. She remained in this situation about 
three weeks without any apparent change, either in size or con- 
stitutional symptoms ; her appetite was good, her features regu- 
lar, skin natural, milk well secreted and suckling her child, bow- 
els regular, and in fact every thing seemingly doing well, except 
inolent periodical pains, which I was informed by the old nurse 
came on every night. 

About ten days ago, some manifestations appeared of failing 
health ; her skin, which was before black and greasy, now became 
ashy and withered ; her features exhibited evidences of distress 
and even anguish. I attributed this however, in a great measure, 
to the extreme suffering which I understood she experienced every 
night. Some four or five days ago I became uneasy, seeing that 
the swelling was increasing. She took calomel and jalap, which 



14 Ovarian Tumor. 

operated well, without any diminution of the enlargement. I got 
my friend Dr. Dashiell again to visit her, who, thinking perhaps 
that it might be a case of hydrometra, made an examination with 
the specalum, introdaced the sound in the uterus, found every 
thing right there, came to the conclusion that there was an accu* 
mulation of water and tapped, drawing off about four gallons of 
sero- sanguineous fluid. After this amount was drawn the flow 
ceased almost entirely ; she was put to bed and stimulated with 
whiskey and laudanum. The next day I found the enlargement 
did not extend as far up in the right and left hypochondriac re- 
gion as it did previous to the tapping, but in other respects re- 
mained as before. No reaction ever came on, though stimulants 
both externally and internally were constantly employed, and she 
succumbed three days after without a straggle. 

In company with my friend Dr. Murchison, a North Caroliniar, 
and my nephew, a post mortem examination was made, which re- 
vealed, upon opening the parieties of the abdomen, an enormous 
ovarian tumor, which, on being cut into, resembled more the ap- 
pearance of the lungs, or that spongy substance, a cow's udder ; 
the color, however, was more like the former. The tumor was 
attached to the broad ligament of the uterus on the right side, 
and the entire ovary was obliterated or absorbed in the mass. All 
throughout the substance you could find cysts, some of which, 
when cut into, would pour out a serous fluid ; others would con- 
tain organized lomps resembling coagulated fibrin. The tumor, 
after nearly all the fluid was evacuated, weighed eighteen pounds. 
I have no doubt it would have weighed, when first taken out, at 
least twenty-five pounds. The whole of the internal walls of the 
abdomen, in the lower part, was thickly studded with tubercular 
deposits ; the bowels were sphacelated and some of the small ones 
were covered in some places with the same kind of deposit ; liver, 
stomach and spleen healthy ; uterus and bladder likewise, with 
the exception of some morbid growths on the latter similar to 
those mentioned above. 

It is strange that this girl should have gone through the entire 
pregnancy without any disturbance of health, and complained but 
little more than is usual with women with their first child. It is 
certainly a remarkable case, and I wish I could delineate to you 
more particularly. 



Foreign Correspondence. 16 



ARTICLE V. 

Foreign Correspondence. — Letter from Dr. P. Cooley. 

London, Nov. 10th, 1860. 

Prof. McPnEBTERS. 

My dear Sir : Just before leaving Lexington, Mo., I received 
a polite note from yon requesting me to correspond occasionally 
for the St. Louis Medical and Surgical Journal. I will try and 
comply with your request. Since my arrival in London, I have 
had the pleasure of witnessing much in the line of surgery. I have 
seen Mr. Skey, Mr. Stanley, Mr. Coote, of St. Bartholomew's 
Hospital, operate ; also Mr. Lane, Mr. Ure, Mr. Coulson, Mr. 
Walton, of St. Mary's; Mr. Curling, of the London Hospital; 
Mr. Fergusson and a Mr. Wood of King's College Hospital ; and 
Mr. J. Baker Brown of the London Surgical Home. I have 
seen Mr. J. Baker Brown operate for vesico-vaginal fistula. The 
operation for vesico-vaginal fistula, I think, is Mr. Brown's 
favorite operation : and I can bear testimony to his great surgical 
skill in performing this very nice and complicated operation. 
Heretofore this has been one of the most difficult, if not the most 
difficult and intractable diseases that fell to the lot of the sur- 
geon ; and even at the present day it is the case in the hands of 
many surgeons, both in this country and the United States ; but 
in the hands of Mr. J. Baker Brown those cases hitherto consid* 
ered almost entirely beyond remedy, make rapid recoveries. It 
is true, there are some failures, even under his treatment ; for to 
effect a complete and entire cure in every instance, would be, to 
say the least of it, almost miraculous. I can not, however, but 
speak in the highest terms of his great surgical skill in this hither- 
to difficult operation, and far more difficult disease to cure. Un- 
der the old plan of operating, patients have undergone the opera- 
tion time and again, and yet without relief ; but after a patient 
has undergone the operation introduced by our countryman, and 
my particular friend. Dr. Bozeman, the cure is almost an abso- 
lute certainty. Mr. J. Baker Brown performs this operation 
with the greatest imaginable ease. In one operation, which 1 
saw him perform, he concluded it in forty minutes, whereas it 
frequently requires two or three or even more hours to complete 
the operation. Mr. Brown does not, or at least, very rarely, 



16 Foreign Correspondence. 

rases Dr. Boseman's button, bat employs a olamp, which is how- 
ever on the same principle of the batton, and I think preferable 
to the bntton. Ho values the clamps higher than the button, 
though it may be to more closely connect his name with the oper- 
ation. He has also made improvements in the needle, which I 
think answers the purpose for which it was designed better than 
the original needle. It is easier of introduction, and the sutures 
can be introduced through the needle with the greatest imaginable 
ease and facility. Mr. Brown deserves great credit for having 
brought this operation to its present state of perfection. By 
speaking of the operation in the manner in which I have above, 
connecting Mr. Brown's name so closely with it, I do not, by any 
means wish to convey the idea that I am aiming in the least de- 
gree to detract from the merits of the operation as performed by 
Dr. Bozeman, for to him belongs the credit of having introduced 
this great improvement. It is certainly gratifying to those who 
are afflicted with vesico- vaginal fistula, to know that there is a 
remedy for them, and that they can be almost certainly cured. I 
find Mr. Brown ready and quite willing to communicate all he 
knows respecting this operation. To his patients, he employs no 
harsh language, but speaks mildly and very kindly ; he is also 
very particular not to inflict unnecessary pain on his patients. I 
would like to amplify, and to somewhat particularize in regard to 
the particular manner in which Mr. Brown operates, but I for- 
bear, because your readers, I apprehend, have had, ere this, 
somethiDg from him on this subject ; and, if so, what I might say 
would be superfluous. I have witnessed several operations for 
the removal of stone in the bladder, but at present will only speak 
of the operation of lithrotrity, as performed by Mr. Skey of St. 
Bartholomew's Hospital. Mr. Skey performs this operation with 
the greatest ease. The first operation I saw him perform for 
crushing the stone in the bladder was in the person of a boy fif- 
teen years of age. In this instance, he introduced the largest 
sized lithrotrite, which in persons of this age is very unusual. 
He operated withovt chloroform, producing little or no pain. Mr. 
Skey, like Mr. J. Baker Brown, is somewhat wedded to the 
operation of lithrotrity. He performs this operation oftener, 
perhaps, than any other surgeon in London* He says it is not 
as often resorted to as it should be. Were those cases taken, 



St. Louts Medical Society Reports. 17 

gays he, in their commencement — in ascertaining the beginning 
of the formation qf stone is the great difficulty — a great ma- 
jority of them might be relieved by lithrotrity, thereby avoiding 
the necessity o£ nsing the knife. I would prefer lithotomy to that 
of lithrotrity, especially in the hands of some of those whom I 
have seen operate. 

The hospitals in London afford a fine field for obtaining sur- 
gical knowledge. Important surgical operations are performed 
at some one or more of the hospitals every day in the week, 
thereby giving an opportunity of witnessing operations daily. 



ARTICLE VI. 
PROCEEDINGS OF THE ST. LOUIS MEDICAL SOCIETY. 

Reported by U. H. Billing slba, M.D., Rec. Sec^ry. 

Opinions upon Dr. Todd^s Pathology and Therapeutics^ as 
promulgated in his work on ** Certain ^cute Diseasesj** 
ire. Obscure case of obstructed Menstruation^ reported 
by Dr. M. M. Fallen. Jinomalous processes upon the 
Occipital Bonesy by Dr. E. J. Marsh. 

Dr. Linton. I desire to call the attention of the Society to a 
work recently pnblished by Dr. Todd, entitled ^^ Clinical Lectures 
on certain Acute Diseases." I regard it as the most remarkable 
work that has emanated from any source for many years. His 
therapeutics seem to have gone ahead of the times. For some 
years back, Dr. L. has advocated the use of the hydro- carbons 
in phthisis. Has also said that the alcoholic stimulants did not 
favor inflammation, and would not increase fever. In some of 
the London hospitals they are given in acute disease. Dr. Todd's 
book is the embodiment of his practice. He devotes but little space 
to pathology and much to therapeutics. It is an old prejudice, 
so he says, to avoid alcoholic stimulants in inflammations and 
fevers. He asserts that his experience fully bears out this doc- 
trine, and gives many cases proving their advantage. 

Dr. L. does not intend to endorse these views in their full ex- 
text. Theoretical deductions led me to believe these agents not 
Vol. XIX— 2 



18 SL LouU Medical Society Reports. 

iDJurious. There are cases of inflammation in which bleeding 
should precede the use of the hydro-carbons. Dr. L. agrees 
with Dr. Todd in the modus operandi of these latter remedies. 
He would not reject mercurials, as they are our most useful 
agents in sub- acute or chronic inflammations. We may not be 
able satisfactorily to explain their action, but all experience 
proves them useful in inflammatory diseases. Is satisfied they 
can cut short inflammation, and of course can not agree with Dr. 
Todd that they are of little avail. So often have I used them 
with benefit in chronic inflammations, where I had objected to them 
in the start, that I am forced to acknowledge their potent influ- 
ence. 

With regard to the necessity for stimuli and nutritious food in 
debility and anemia, there can be no doubt. With the few excep- 
tions just mentioned, and the ultraism of his stimulation, I can 
endorse the work of Dr. Todd, and advise its perusal. The read- 
ing of the work will have an influence upon my practice, in en- 
couraging me to use stimulants where I before thought they were 
contra-indicated. 

People may differ in the use of terms. The terms sthenia and 
asthenia, respectively, mean strength and weakness. All diseases 
produce debility, and thus asthenia is one of the first symptoms. 
Active congestion and inflammation are sthenic only in a certain 
sense ; their tendency is to produce an asthenic condition of the 
general system. But we have two classes : first, those diseases 
which are universally asthenic, as the fevers ; and secondly, those 
in which T^e have local sthenia and general asthenia. Increased 
power of the brain and active secretion of the liver are both ex- 
amples of local sthenia, and these may be associated with an 
asthenic condition of the general system. In those diseases in 
which we have local as well as general asthenia, we must always 
employ supporting treatment ; but when local sthenia is combined 
with general asthenia, we must temporize. 

Dr. M. M. Fallen. There is a fashion in medicine as in poli- 
tics. Facts do not change, but men's opinions alter very much. 
Thirty years ago, a very remarkable book on fever made its ap- 
pearance, which was pronounced by the Med. Ohir. Rev. not only 
the best book on fever, but the best book of any kind. This was 
the work of Dr. Southwood Smith. He advanced the doctrine 



St. Louis Medical Society Reports. 19 

that all fevers were sthenic diseases, dependent apon inflamma* 
lion, and that this inflammation might be either in the head, thorax 
or abdomen. Hence all fevers were to be treated antiphlogisti- 
eally. That book had its day and its adherents. Thirty yenrs 
have elapsed and the doctrines of Soathwood Smith are now old 
fogy notions. There is really nothing new in these doctrines of 
Dr. Todd ; merely a revival of views that have had their day 
long ago. 

Dr. T. assumes that all inflammations wQl run through a natu- 
ral course, and that we must support the system while the elimi- 
native process is gone through with. Is this a fact? . Can we 
not cut short an inflammation ? Have we nothing else to do but 
give eliminatives and support the general system? What is in- 
flammation? We are told that it is some disturbance between 
nutrition and decay ; too much supply and too little decay, or 
vice versa. 

Let us put the question in another form — ^what does inflamma- 
tion appear to be to the naked eye? First, increased flow of 
blood into a part; secondly, stasis of the blood in the capilla- 
ries, adhesion of the corpuscles to the sides of the vessel and to 
each other, and exudation of lymph. We may call this a lesion 
of nutrition if we choose, but the facts are as stated. If the in- 
flammation be sufficiently severe to react upon the general circu- 
lation, we will have increased actioutof the heart and arteries. 
As a result, in plain language, we find destruction of the parts 
takes place. This destruction exerts such an influence that the 
disease is protracted in its duration, or death ensues. We further 
observe, that when such an inflammation can be seen, those reme- 
dies that arrest the too frequent action of the heart and arteries, 
will, by preventing too free flow of blood, diminish the activity of 
the inflammation. 

Still further, it has been proved that the withdrawal of blood 
from the system will sometimes cut short a conjunctivitis ; and if 
this can be done, so also can you stop a pneumonia. We can 
not explain why a particular part of the lung is attacked ; bat 
experience teaches us that remedies that impede the action of the 
heart and arteries will do good. For these reasons, I can not 
agree that inflammation will run a certain course ; but, if possible, 
I arrest the disease, and at the same time prevent debility. The 



20 St. Louis Medical Society Reports. 

very means that are used to cat short the disease do not lower 
the system, but rather elevate it. The abstraction of the blood 
relieves the system of the incubus that rests upon it, and as the 
blood flows the patient gets stronger. It is a practical error to 
suppose, that because the results of disease lead to debility, there- 
fore the system must be supported, ab initio^ for that debility. 
Who has not seen pneumonia cut short in the first stage? I have, 
and I think the experience of all will bear me out in this asser- 
tion. But pneumonia may run on to the stage of deposition, and 
then we must use those remedies for which Dr. Todd has such 
fondness. It is true, after deposition has taken place we have 
debility, and we must use supporting remedies ; but are there no 
measures that will assist the removal of these deposits, and must 
we wait for nature alone to accomplish it? Dr. Hope on his 
death-bed stated, that if there was anything which he fully be- 
lieved, it was the power of mercury to produce absorption. I 
allude to this, because I can substantiate the views of Dr. Hope. 
Day by day, while going the rounds of a hospital, have I seen 
and pointed out to oUiers, the gradual decrease of the dull sounds 
under the influence of this remedy. Facts like these can not be 
gainsaid for fashion. There are, however, many inflammatory 
diseases that demand no depletion. 

Dr. LiNTOK. I endorse Dr. Fallen's views pretty heartily. I 
can not see much difference between his views and those of Dr. 
Todd. The difference is more of degree than of kind. Where 
they do not agree, I am inclined to think Dr. P. correct. When 
you say a disease must run a certain course, you come pretty near 
the truth, but not entirely ; for some can be shortened. This book 
of Dr. Todd's, although very good, is not the most logical I ever 
saw. In one place, he decries the use of depressing agents under 
any circumstances, and in another he advocates bleeding, or at 
least admits its utility. In this he would contradict himself, 
unless bleeding is not always a depressant, as asserted by Dr. 
Fallen. 

In syphilis and intermittent fever, wo certainly cat short dis- 
ease, which if left to itself might run on to a fatal termination. 
I endorse entirely the opinions of Dr. Hope as to the efiScacy of 
mercury. No fact is better established, as I have before stated, 
than that mercurials do cure subacute and chronic inflammations. 



Si. Louis Medical Society Reports* 21 

I hare used them frequently in these eases, and, simultaneously 
with the tenderness of the gums, benefit ensues. This seems to 
be the general opinion of the profession. I also endorse Dr. 
Fallen's statement, that there is no change in the type of disease. 
The fact of our not bleeding does not depend on any such change. 
Blood-letting could only strengthen indirectly, not directly. It 
may, by diminishing the action of particular organs, increase 
that of others. We may call cold a stimulant ; for by contract- 
ing the capillaries of the skin, it has a bracing effect upon the 
system. So also the sedatives may act indirectly as stimulants* 
We must always keep in mind the direct and indirect effect of 
remedies. It is important to remark a local sthenia or a local and 
general asthenia. I believe there may be sthenia of a particular 
part. In asthenic diseases the stimulants and tonics would be 
the remedies. In what is usually called asthenic disease, it would 
be necessary to deplete the local sthenia, and watch the general 
asthenia, as in inflammation of the lungs, which is locally sthenic 
and generally asthenic. 

Alcohol is a stimulant and not a nutrient to any tissue — may 
nourish indirectly, but not directly. It is respiratory food, and 
nourishes by saving. When but little nourishment can be taken 
in, if we can introduce material for respiration, we shall accom- 
plish much. There are no general sthenic diseases. 

Dr. M. M. Fallen. In some previous remarks on this sub- 
ject, I endeavored to show in how far I differed with Dr. Todd. 
I attempted to show that blood-letting really acted by relieving 
the vital powers. With his second proposition I differed, be- 
cause if we accept this in totOj we must allow that all diseases will 
run a certain course ; while I contend that we can cut short — can 
do more than support the system— can prevent lesions which 
would so interfere with the organism as to cause death. His 
third proposition is but a corollary of the second. It is clearly 
the object of Dr. Todd to establish the doctrine that antiphlogis- 
tics are not to be used. He belongs to the school of Hughes, 
Bennett, and others, who believe that a disease is mainly to be 
cured by the use of remedies which support the system during its 
continuance. There are many truths in Dr. Todd's work, and 
they have been recognised as such for a long time. While old 
physicians recognised the importance of antiphlogistic measures. 



22 Si. Louis Medical Society Reports. 

thej also incalcated the necessity, under proper oircamstanoes, of 
the opposite form of medication, both in inflammatory and non- 
inflammatory diseases. It is to the exclusiveness of his doctrines 
that I object, and not to the doctrines when applied in the proper 
place. There can be no donbt that the nse of alcohol is de- 
manded in certain forms of ferer and asthenic inflammations ; for 
I still believe in the use of the terms sthenia and asthenia. I re- 
cognise the difierence between the prominent features of these two 
forms of disease ; and as the profession have agreed upon these 
two terms, they should be preserved. 

The asthenic form of inflammation is that to which alcohol is 
adapted as a remedial agent. Take, for instance, certain forms 
of phlebitis. This disease may commence in a very sthenic 
form, but so soon as pus begins to circulate, we have a condition 
so plainly asthenic, that he who runs may read. We have here 
an inflammation, but not such an one as will bear depletion. 
The system is depressed by the poison, and we must use alcohol 
as the remedial agent ; and for the manner in which it acts, and 
the proper mode of its administration, I can refer you to Dr. 
Todd's excellent remarks upon the subject. 

Three times in my life have I been prostrated by the effects of 
heat, and in each instance under the influence of alcohol the sys- 
tem reacted. Alcohol is the special food of the nervous sys- 
tem. Taken improperly it destroys the nervous system, not 
by active inflammation, but by interference with digestive and 
other processes it so injures the tone of the nervous system, that 
coma, paralysis, &c., will follow. When a man is dead- drunk, 
he is comatose. Tremors follow from its constant use. Too 
much alcohol taken at once may cause paralysis. In typhus or 
typhoid fevers, alcohol is also a necessary remedy. In phthisis it 
is also of service when given properly. I do not wish to be un- 
derstood as objecting to the use of alcohol ; for while I disagree 
with Dr. Todd in the treatment of sthenic inflammations, while I 
believe such need blood-letting and antiphlogistics generally, I 
agree that alcohol is proper in asthenic diseases — consumption and 
diseases of that character. 

I took occasion one year ago, when discussing a subject some- 
what similar to this, to state that the type of disease had not 
changed, and this I still believe. I do not believe in the phases 



St. Louis Medical Society Reports. 28 

of inflamination, as insisted upon by Dr. Watson. Locality lias 
much to do with making disease sthenic or otherwise. Dr. Todd 
has derived his experience from the crowded wards of London 
hospitals, and hence deprecated antiphtogistios ; while we, and 
others, who practise amid more salubrious influences, very fre- 
quently meet with cures that require the lancet and other so- 
called depletions. 

Dr. White — ^I did not intend making any remarks at this time, 
having previously, a year ago, presented my views to the Society 
on the therapeutic action of alcohol, it being the type of stimu- 
lants most prominent among the hydro* carbons. The pathology 
of inflammation, and its treatment by stimulation and feeding, is 
especially interesting at the present time. The late work of Dr. 
Todd on ^^ certain acute diseases," is a characteristic work, and 
contains many important suggestions and points worthy of care- 
ful analysis ; some of these, it appeared to me, have not been suffi- 
ciently considered, and others entirely overlooked. 

One of the most important is, whether acute diseases have 
changed their type since the earlier writers recommended the an- 
tiphlogistic treatment, and have become asthenic in their nature, 
requiring supporting remedies ; or, whether indeed these diseases 
have not always been asthenic. Dr. Todd affirms the latter. After 
apologising for his ^< venturing to dissent from current views of 
pathology and practice, sanctioned as they are by great names, 
both living and dead, for which he will yield to no one in admi- 
ration and respect,'^ he explicitly declares his position by assert- 
ing ^* amicus Plato, amicus Socrates, magis arnica Veritas?^ 
Now, if he be correct in dissenting from the current views of pa- 
thology, in affirming that all acute disease is asthenic in its na- 
ture, then are stimulants demanded from the beginning, and it 
would appear indeed that this is his view (though in his clinical 
reports we do not find \i to be his practice), from the following : 
^^ I can not too strongly impress you, that to do good with stimu- 
lants you must use them early," &c. Even in asthenic gout he 
uses alcohol from the beginning. 

I consider Dr. Todd at fault, therefore, both in his general and 
special pathology, in considering all acute diseases asthenic, and 
inconsistent with his therapeutics, which is for the most part 
faultless. 



24 SL Louis Medical Society Reports. 

Dr. Linton, recognizing the division into sthenic and asthenic 
inflammations, has given us an analytic view of their distinctive 
nature ; it occurred to me, however, that he did not make a suffi- 
cient distinction between local and general disease. It may be a 
question also, whether the local affection may not be a type of 
the general pathological condition, it being in an exalted or de- 
pressed state ; that is, may disease ever, per se, be sthenic or 
asthenic locally, while the system as a whole is otherwise ? 

Another point : Dr. Todd has drawn his views of pathology 
from isolated facts, collected in his clinical observations made 
under peculiar circumstances, in the wards of a London hospital. 
These cases can not be considered a fair manifestation of acute 
disease at the present time, and this mode of induction may be 
safely questioned. The type of disease, seen in the well venti- 
lated homes of rural districts and under the influences of a differ- 
ent climate, is quite the reverse. 

Another very important point regarding the therapeutics of 
Dr. Todd, and which I think has been overlooked is, whether 
alcohol is a tonic or nutrient. He affirms that it is food for 
nerve tissue, with which it is almost identical in chemical compo- 
sition, and being readily absorbed, it is at once appropriated for 
the repair of wasted nerve structures. Placing his argument on 
the premise that asthenia arises from the destruction of nerve 
tissue, and that alcohol is food for this tissue, he assumes his 
therapeutics, and concludes that it is not injurious to overstimu- 
late with this remedy. He says, ^^ I am convinced that it is bet- 
ter to overstimulate than not to give enough, for if we have 
overstimulated a patient, it is easy enough to pull him down 
again." This certainly cannot be confuted, nor will it be neces- 
sary to pull him down^ for he will come down quickly enough 
in consequence of the overstimulation ; thus, instead of gaining 
increased nutrition, we have increased disintegration, and loss of 
nervous power, with not unfrequently fatal depression of the vital 
actions. 

Dr. Miller of Edinburgh, and many other learned authorities, 
both in Europe and in this country, claim that alcohol is nothing 
more than a medicine — a stimulant or poison ; while an equal array 
of authorities affirm that it is respiratory food, and thus an indi- 
rect tonic. I am not prepared to controvert Dr. Todd's position; 



Si. Louis Medical Society Reports. 26 

for, it is nniyersally admitted, that alcoholic stimnlants exert 
especial influence over the functions of the nervous system ; but 
that it is food for the repair of those structures is not quite so 
clear ; nor can it be denied that the judicious use of these agents 
in cases of nervous depression and exhaustion, does restore tone 
to the system. 

Some chemico-physiologists contend, in opposition to the 
views of Leibig, Prout, and others, that alcohol undergoes no 
change in the blood, but when taken in too large quantities it is 
eliminated through the emunctories, Miaihe affirms, that it 
never is excreted in the urine. Yierordt found less, while Dr. 
Prout found more, carbonic acid eliminated through the lungs 
during the ingestion of alcohol, than was normal. In a late re- 
port of Lallemand, Duroy, and Perrin, made before the Academy 
of Science at Paris, after laborious researches, the following con- 
clusions were affirmed, viz : 

1. Alcohol is never an aliment; it acts only as a modifier of 
the nervous system. 

2. It is never decomposed or transformed in the system. 
8. It principally concentrates itself in the brain and liver. 

With this contrariety of opinion, the question becomes at once 
important and interesting. I believe that alcohol does produce a 
deposition of fat, sometimes even amounting to disease, as in 
fatty degeneration. Yenosity is a disease that may be caused 
by the judicious use of alcohol, the fatty oils and nutritious diet, 
antagonistic to tuberculosis, if Bokitansky and universal experi- 
ence be correct. Here is one disease less perilous to life substi- 
tuted for one that is more dangerous. Now the question arises, 
is this the action of alcohol in the system ? We answer, the thera- 
peutic action of alcohol is two- fold, physiological and pathologic 
cal : the one merely stimulating normal vital action, the other 
altering the vital changes to abnormal action. The former cures 
by exciting the function of organs, and the latter by altering the 
function. We should therefore exercise discretion in the admin- 
istration of this, as in the use of any other poison, such as opium, 
belladonna or aconite. Because the vital changes do not go on, 
is no reason that alcohol may not be contra-indicated. This would 
be irrational empiricism. While escaping the dangerous extreme 



S6 Si. Louis Medical Society Reports. 

of depletion, we should be careful not to lose the channel of truth, 
by plunging into the no less perilous extreme of overstimulation. 

The less injury we do in curing disease, the more true we are 
to our patients ; and it would be better, if by bleeding we cause 
sedation with less actual depression, than to first overstimulate 
the heart and arteries, thus causing destruction of the peripheral 
branches and an uncertain amount of exhaustion, though we 
should obtain the same result. The destruction of tissue may be 
more difficult to repair, than to restore to the blood the loss of 
a large amount of the nutritive material, abstracted by bleeding. 
Better far to lose some nutritive matter, than to force into a 
part an excessive amount of the very elements necessary to be 
carried off. 

Alcohol, when administered in narcotic doses, may become anti- 
phlogistic and cure even sthenic inflammations ; but this mode of 
treatment would be far more hazardous than bleeding, antimony 
or yeratrum. 

Dr. Watters — ^I had no intention of making a speech upon this 
subject, but finding in the North Amer. Med. Chi. Review a 
statement that the views which I have held and promulgated for 
some time past, foreshadowed those of Drs. Todd, Bennett, and 
others, I deem it necessary to state that such is not a legitimate 
conclusion. 

The first proposition of Dr. Todd is, << that the notion so long 
prevalent in the schools, that acute disease can be prevented or 
cured by means which depress and reduce vital and nervous pow- 
er, is altogether fallacious." I believe, sir, that we can cure by 
depressing and reducing means. Suppose, for example, you cut 
your finger ; by bringing the edges of the wound together, union 
may take place without inflammation. The means that would 
be used, would be such as depress vital power ; for in preventing 
the introduction of air, and in keeping the temperature reduced 
by cold water, you are using depressing means, as disintegration 
is the vital motor. 

Inflammation results from disintegration being proportionally 
above nutrition. The causes of inflammation are either an in- 
crease of the destructive changes or diminished nutrition, and the 
indications in its treatment are, either to diminish the disintegra- 
tion or to increase the nutrition, or both. In the work of Dr* 



SX. Louis Mediccd Society Reports. 27 

Todd only one means or method is taken into consideration, that 
is, to increase nutrition. All the antiphlogistics, so called, tend 
to diminish destructive changes, and hence meet one indication. 

The question comes up, if this be true, how are we to use our 
remedies 7 Shall we rely on one or both ? In the first example 
we cited, we rely upon the first method, preventing destructive 
changes — by excluding the air and keeping the temperature re- 
duced. Almost all idiopathic inflammations, or those which de- 
pend upon increased destruction, will bear active antiphlogistic 
treatment in the beginning. I believe blood-lotting is very bene- 
ficial in some cases, because the destructive changes are due to 
the introduction of oxygen, and the red corpuscles of the blood 
carry this to the tissues. If we bleed, we diminish the red cor- 
puscles but not the plasticity of the blood. You bleed for the 
same reason that you draw the wound together, and apply cold 
water, that is, to lower the destructive changes. I do not believe 
that tartar emetic or mercury lower the plasticity directly, but 
secondarily, by diminishing disintegration. Our object should be 
to re-establish the balance between destruction and nutrition. 
By lowering destructive changes we diminish vital power, and 
hence we must use agents having this efi'ect judiciously and not 
as routine practice. Tartar emetic and calomel in so far as they 
lower the plasticity in inflammation do harm, as the object is to 
restore the balance. 

Alcohol is a stimulant; all stimulation is due to destructive 
change. Experiments of Dr. White prove this. We must sus- 
tain vital power, says Dr. Todd ; but in a changed organism, the 
stimulants are wasted — they produce direct debility. We are much 
more debilitated after the use of Alcohol than before it, if the 
organism is so deranged that the power thus developed does not 
become vital power, because every motion and action of the body 
is produced by destructive changes. A patient has been very ill; 
you advise exercise in the open air, because as you increase the 
waste the power is developed and appropriated for the purposes 
of nutrition ; but if the power is not dius appropriated from de- 
ranged organization, exercise is most injurious. Alcohol should 
be given for the same purpose. 

It is a difiScult thing to draw the line between the necessity for 
a stimulating or an opposite mode of treatment. The power 



28 Si, Louis Medical Society Reports. 

developed by stimulants in the early stage of inflammation can 
not be appropriated, and here we must rely more npon agents 
which diminish disintegration. Unless the power developed by 
stimulants be used so as to cause vital motion, what is the use of 
it ? I believe we would better enable the patient to run through 
typhoid fever, by preventing the power from being developed. 
If all power in the body involves waste, certainly it must be inju- 
rious to increase the power, if the organism is so changed that 
the power can not become vital power. These are the views 
which I think are foreshadowed by my essays. 

Dr. E. J. MARsn exhibited to the Society two Indian skulls, 
which presented a peculiar process on the occipital bone. They 
were obtained from Fort Berthold on the Missouri river, at the 
village of the Arickaree tribe of Indians — one was procured by 
Dr. Eennard in the spring of 1858, and the other by Dr. Marsh 
in 1869. The latter is now in the possession of the Academy of 
Science of this city. The first is that of an adult, and presents 
the following peculiarity : On the base of the skull, directly ex- 
ternal to the condyle of the occipital bone, there is a large pro- 
jecting process of an oval shape with its long diameter antero- 
posteriorly. The process on the left side is about three-fourths 
of an inch in length, and one half inch in its greatest diameter at 
the base. The surface is rough, the extremity rather pointed, 
but on its anterior half there is a distinct articular facet. On the 
right side this process is somewhat smaller, and its extremity has 
been broken off. 

The second skull is that of a child about eleven years of age. 
This presents also processes of the same nature and situation, 
although proportionally somewhat smaller than those of the first 
skull. Both present articular facets on the extremities. 

Dr. Marsh had examined other Indian skulls from the same 
locality, in which no such process was found. From the situa- 
tion and nature of these processes they appear intended to articu- 
late with the transverse processes of the atlas. 

Dr. M. M. Fallen reported the following interesting case : 
On last Monday night, I was called by Dr. Pope to see with 
him a lady from the country, who had suffered for two months the 



SL Louis Medical Society Reports. 29 

most intolerable anguish from what was supposed to be a retro- 
version of the womb. She had not menstruated for two months 
previous to the occurrence of the retroversion^ and had also given 
other signs of pregnancy. Her bearing down pains, as she de- 
scribed them, must have been somewhat similar to the tenesmus 
of dysentery. Upon introducing my finger into the rectum, a 
tumor could be distinctly felt. A vaginal examination revealed 
a remarkable state of things. The vagina measured but two 
inches in length anteriorly, while posteriorly, the shortening was 
remarkable, it measuring but one inch. There was no di£Sculty 
in micturition. No neck of the womb could be felt. If there was 
a retroversion of the uterus, and the neck could not be felt, it 
must be high up, and consequently the anterior vaginal wall 
would have been lengthened, and there would also have been diffi* 
culty in urination from the pressure of the neck of the womb 
against the bladder. Three fourths of an inch above the os va- 
gina, there was an opening, but no neck of the womb. Now, was 
this the OS uteri or merely a fold of the vagina? It was so near 
the orifice that it could easily be seen by separating the labia, and 
it had the appearance of the os uteri, but no neck could be dis- 
cerned. If the tumor felt against the rectum was not the uterus, 
where was it? The bladder and rectum were in situ ^ and the 
tumor ought to be the uterus, and low down as the opening was, 
it ought to be the os uteri. 

I was puzzled. Dr. Pope as well as myself had attempted to 
reduce it and failed. I endeavored to introduce the uterine 
sound into the opening, but it would not pass to any depth. The 
patient was left for the night, two grains'of morphine having been 
administered as usual, to give rest. We met again next morning, 
and came to the conclusion, that there was either a pregnant uterus 
retroverted, or that the uterus was closed at the os internum, and 
contained menstrual fluid ; and it was determined to pass an in- 
strument through the opening, which would either rupture the 
membranes and produce abortion, or discharge the menstrual fluid, 
as the case might be. I again attempted to pass the sound, but 
could not succeed, although, with the finger in the rectum, I some- 
what elevated the tumor. Detecting some fluctuation in the tu- 
mor, I then used a curved trocar, plunging it through the os uteri 



80 On Physiology and Pathology. 

in the proper direction, and a quart or more of menstrual fluid 
gushed out, to the complete relief of the patient. 

Now, why was the vagina so much shortened ? I could not get 
an accurate history of the previous confinement ; but I believe 
that laceration and inflammation took place at that time with 
sloughing of the vagina, and the uterus having descended united 
with the vagina below, thus producing shortening and perhaps 
the occlusion. Several years since, I saw a case of occlusion of 
the womb in a young lady from the country. The abdomen was 
much enlarged, and her aunt, who accompanied her, insisted that 
she had menstruated regularly. I punctured the uterus through 
the vagina with Simpson's exploring needle, and relieved her. The 
vagina in this case was of the usual length. I advised her physi- 
cian to gradually dilate the os, but it was not attended to, and 
the fluid reaccumulated ; again it was let out, but only to re- 
appear; the third time it was punctured, peritonitis followed and 
resulted in death. 



ARTICLE VII. 

Report of the Committee on Physiology and Pathology. 

The Committee, to whom was referred the subjects of Physiol- 
ogy and Pathology, have found the time insufficient for the pre- 
paration of a full report ; and in view of the fact that the Society 
could not anticipate, from this your first Committee, during the 
brief period since its appointment, a complete resume of the 
progress of these sciences, it has attempted no more than a par- 
tial, and, it is feared, very imperfect review of such points as its 
limited opportunities have furnished. The report promises, there- 
fore, a consideration of such items only as were at hand, and not 
a result of laborious research. It is a matter of regret, also, to 
your Committee, that many facts and opinions developed in the 
fruitful labors of physiologists and pathologists during the last few 
years — some reformatory and others confirmative of previously 
received doctrines, and full of interest to scientific medicine — ^have 
of necessity been entirely ignored ; they hope, however, that the 
various subjects that will be presented may be found worthy of 
your favorable notice and critical review. 



On Physiology and Pathology. 81 

Soon after its appointment, the Committee met for the purpose 
of arranging and dividing the work, when the following division of 
the subjects was agreed upon ; assigning to each member the dis- 
tinct topic in tbe order that his name stands upon the Committee, 
viz: first, Tbe Physiology of the Nervous and Muscular Systems, 
by F. W, Whitb, M.D., Chairman; second, Tbe Physiology of 
the Circulatory and Glandular Systems, by E. J. Marsh, 
M.D. ; and third, General Pathology, by G. H. E. Baumqabtbn, 
M.D. In pursuance of this plan, it has been the object of each 
member of the Committee to present, not so much his own views, 
as a concise and just exposition of such facts, theories, and opin- 
ions, as have recently appeared, or which, in consequence of their 
connection with the subject, claim attention. 

I. Nervous and Muscular Systems. 

Human Physiology, or the study of man and his relations, has 
an essential position, and the physiology of the nervous sys- 
tems the preeminent place, in the noble science of organic life ; 
and yet up to the present very little is determinate regarding its 
intimate structures and special functions. One fact, however, is 
quite clear, namely, that it exerts a controlling influence over the 
formation and development of the material — ^its decay and repair — 
and the unceasing roll of its life- actions ; while its mysterious 
and apparently essential relation to the manifestations of the im- 
material, point authoritatively to the importance of its study. The 
development of the nervous system in all animals is in direct ratio 
with the position they occupy in the scale of intelligence, showing 
conclusively that the correlations of mind and matter are essen- 
tial to be understood in attempting to know what is ^^Life." 
Metaphysicians in looking upon the developing magnitude of the 
physical sciences, and their rapid progress toward positivism, with 
unwarranted fears have regarded them as a tendency of the age 
to the dethronement of moral truth ; whereas they are gathering 
about it as an impregnable bulwark. A knowledge, therefore, 
of mental physiology asssists in explaining the true relations of 
the finite to the Infinite Intelligence, and should be among the 
earliest lessons of the moralist in seeking the noblest of truths-— 
Moral Truth. Truth corroborates truth ; and the material often 
becomes the instructor of the immaterial. In this age, Common 



32 On Pkyinology and Pathology. 

Sense asserts the supremacy ; and will decide as the arbiter be- 
tween this pseudo-metaphysical assumption and the authority of 
legitimate truth ; nor will she disregard the wonderful connection 
existing between the mental and the merely physical. 

The study of Mental Physiology is full of wisdom and beau- 
ty, and its growing importance has called forth, during the last 
two years, the publication of two very characteristic works ; one 
from Dr. Noble in 1858, and the other from Dr. Lay cock during 
the present year. We have opportunity to notice only a few 
points in the latter work, which is entitled ^^ Brain and Mind ; or 
Correlations of Consciousness and Organism.'' He considers 
the study of physiology essential to the establishment of mental 
philosophy ; and the supposed antagonism of the sciences to Reve- 
lation, not real ; that the relation of soul to body, mind to mat- 
ter, and their reciprocal activities, are not understood, because 
not studied in the light of physiology. He would study the con- 
nection between man and his organism, or between ^^ himself 
and At^" — himself remaining unchanged, while his is continually 
being altered. In his correlations, the laws of thought are com- 
pared with the minute anatomy of structure, and the laws of its 
functions, volition and thought being exercised through the me- 
dium of the nervous system. 

The greater part of the work was designed and has been 
performed, without doubt, for the sustentation of a theory pe- 
culiar to himself. He accounts for all the phenomena of men- 
tal and organic being by an immaterial, inherent, energy — an 
adapting power, or force, ever operative in the vital processes, 
whose laws can only be understood by ascertaining those of the 
living organism. This "energy," "mind," or "soul," has no 
conscious existence in itself, but is developed through the func- 
tions of the nervous system, and is the unconscious receptacle of 
impressions from the Divine Mind, which are manifested in the 
phenomena of organic life. He considers it an error to endeavor 
to establish the doctrines of consciousness, by inquiring how 
mindi knows n,ni feels; the question should be, how mind ex* 
ists. He contends that consciousness of unity and personality, 
depends on the correlation of life and mind. 

The term correlation, as here appiied to consciousness and or- 
ganism, may be understood to indicate that under certain circum- 



On Physiology and Pathology, 38 

stances, they are capable of giying rise to each other; that 
each may transform the other, not howeyer possessing any essen- 
tial attribute in common ; this is not ^^reciprocal relation" sim- 
ply, it is more. He affirms the existence of an essential and in- 
separable connection between the phenomena of mind and the 
functions of the brain ; that the innate mental faculties of man, 
and the instinct of inferior animals, do not differ essentially in char- 
acter, but only in the degree of their development, and that they 
are not separable by any definite line. Oomparative psychology 
stands, therefore, in the same important relation to mental philoso- 
phy, that comparative anatomy holds to mental physiology. 

In our present state of being the activities of mind and body 
are so closely conjoined, particularly that of intellection and the 
development of brain, that it is impossible to know the one with- 
out the other. The question, however, as to the existence of con- 
sciousness and the thinking principle in the intermediate state, 
independently of the body, is one not of physiological enquiry, 
bat of metaphysics alone ; while the study of the living and con- 
crete man belongs to the practical psychologist. He does not 
undervalue the importance of logic and metaphysics, but thinks 
the great error of metaphysicians to consist in their abstract rea- 
sonings upon both the operations and products of mental effort, 
without considering in the concrete how far they are affected by 
the living organism. 

This is Dr. Laycock's great work, and, though written in the 
most difficult and obscure style, possesses much merit, and must 
command the thoughtful attention of all scientific physiologists 
and metaphysicians. The subject is treated under the following 
classification, viz : I. Preliminary Dissertation on Method. U. 
Metaphysics. UI. Mental Dynamics. lY. Principles of Scien- 
tific Psychology. V. Principles of Mental Physiology. VI. 
Principles of Mental Organology. To this may be added his 
claim to priority over Dr. Carpenter in the ** discovery of the 
law of unconscious cerebral action" or ^'reflex action of the 
brain." 

In discussing mental dynamics, he treats — 1st. The correlations 
of cause, or first principles ; 2d. Biology — correlations of vital 
forces — correlations of vital and physical forces — correlations of 
Vol. XIX— 3 



34 On Pkyjiiology and Paihotogy. 

▼ital, pbyaical, and mental forces. In the article on '^Mental 
Physiology," his *' Historical Review of Researches into the Law 
of Cerebral Differentiation with Unity of Fanction," and *^ The 
Physiognomonic Method of Research," are replete of interest. 
His article on ^'Mental Organology" is an able and elaborate 
treatise on the anatomy and physiology of the neryoas system. 
He thoroughly discusses the '^ doctrine of organization in relation 
to the various states of consciousness, which constitute in their to- 
tality the mental life of man." Granioscopy and phrenology, in 
his opinion, disregard the ^Maw of unity in multiplicity and mul* 
tiplicity in unity, which is the fundamental law of both mental 
and vital processes." Of this truly great work our space would 
allow only this very meagre and imperfect review. 

Structure and Histology of JSTerve Centres. — ^Prof. Jacubo- 
witsch of Russia, who has been engaged for several years labor!* 
ously in the microscopic study of the nervous centres, presented 
to the Academy of Sciences, Paris, in May last, a paper on 
the peripheral terminations of nerves. He arrived nt the follow- 
ing conclusions : 

1. Every nerve, of whatever nature, originates in a nerve- cell 
in the central organs of the nervous system, and terminates in 
the periphery or in the interior of an organ, either in a nerve- cell 
or by forming a capillary network, in which the anatomical dif- 
ferences disappear by the transition of one axis cylinder into 
another. 

2. The nervous system forms, like the vascular, a whole, and 
penetrates, like this, the organism in all its parts, and divides into 
the last elements — without, however, being lost in any indistinct 
manner. 

8. The nerve elements, i. e., the nerve cells and axis cylin- 
der, are continually being formed anew and further developed in 
the central organs, as well as in the periphery. 

4. The destination of nerve cells is various ; they either exe- 
cute specific functions, as in the nerves of special sense, or they 
serve for the preservation of the organs in which they are located, 
as in the glands and mucous membrane. The physical function 
of the organs is dependent on the co-operation of the nerve cells, 
in the central parts of the nervous system. 

5. Although the anatomical difference disappears, in the capil- 



On Physiology and Paihology. 85 

lary network of the nerve terminations , by the coalesoenee of the 
axis cylinders with one another, yet the physiological difference 
remains just as is the case in the vascular capillary network." 

In a former paper, this distingaisbed young physiologist pre- 
sented the following conclusions as the basis of his researches : 

*-l. Three entirely distinct functions of the nervous system, 
mobility, sensibility, and organic action, are not only exercised 
by three different orders of nerves ; but, moreover, these orders 
of nerves take their origin in different central anatomical elements. 

** 2. The medulla spincUis^ whence arise the general nerves, 
contains equally and naturally the three orders of elements ; but 
the brain, the organ of the intellect, contains but the elements of 
sensibility, and the nerves of the special, senses are also made of 
die same element, with whicH is united in small proportion only 
the ganglionary element. 

** 8. The element of sensibility is in different dimensions in man 
and animals, being larger in the former and smaller in the latter ; 
so that for even an equal cerebral mass, the human brain is much 
richer in sensible elements than is that of animals." 

Prof. Lenhossek, in 1857, presented some very interesting views 
to the Academy of Sciences at Paris. The following is a brief 
synopsis, viz : The nervous centres are composed of white, gray, 
and an intermediate substance, which is gelatinous. The white 
is composed of primary fibres which terminate in radiations in the 
various nervous centres. The gray is composed of three classes 
of nerve cells : 1. Nerve cells with all their elements diffused ; 
2. Nerve cells with all their elements united into groups, and 
these are found both in the motor and sensitive nerves ; 8. Round- 
ed nerve cells with all their elements discolored with a dark- brown 
pigment. These form the ferruginous substance. The interme- 
diate or gelatinous substance is formed by the commingling of the 
gray substance and the fasciculi of the white substance. In the 
spinal marrow, the gray substance constitutes four columns, two 
anterior motor and two posterior sensitive. In the medulla ob- 
longata, these four columns change their relative positions, the 
anterior becoming internal, and the posterior becoming external. 
The motor columns extend to the third ventricle and are lost in 
the infundibulum, the sensitive passing into the thatami opti- 
eorum and corpora striata. At the point where the four col- 



86 On Phynotogy and Pathology. 

nmns commingle the commissure ceases and the prolongation of 
the gray substance forms the median cloison of Ficq iPAzyr ; 
this continues through the ponn varolii. 

The primary fibres of all nerves originate in the gray substance, 
sometimes by prolongations of the nerve cells, but generally they 
appear in groups without any distinctive origin ; they never assist 
in the development of the white substance, nor does the white as- 
sist in the formation of the roots of the spinal nerves. The 
motor roots of the spinal and cerebral nerves originate in the 
motor columns, and the sensitive roots of the spinal and cerebral 
nerves originate in the sensitive columns. The roots of the mix- 
ed cerebral nerves, as the two superior roots of the spinal or ao* 
cessory nerves of Willis, and the par vagum, originate in both 
jolumns. The primary roots of the nervous plexus of the pia 
mater and all the roots of the spinal, except the two superior, 
arise in the periphery of the gray substance. The corpora olivaria 
are formed of an external gray substance and an internal white 
substance, the former being in convolutions. 

The Function of the Cerebellum. — M. Flourens, and others, 
teach that the function of this organ is for the co-ordination of 
muscular motion, and not for intellection, nor for the exercise of 
muscular power ; while M. Foville affirms that it is for cognizing 
sensations conducted to it from the muscles, and thus enables the 
mind to modify and direct their action ; while, again. Dr. An- 
drews, the learned Professor of Surgery in the Lind University, 
contends ^^ that while it may be true that the mind, through the 
cerebellum, co-ordinates motions, it does not do so because it 
possesses a specific function of co- ordination, but simply be- 
cause its action is directly excito-motor.'^ Dr. Rolleston con- 
siders the cerebellar physiology of Schroeder Van der Eolk, regard- 
ing the function of the corpora olivaria as established, and reduces 
the two prevailing theories, as to sensibility and co-ordination of 
muscular movements, to one proposition: '* complicated bilateral 
movements postulate two sets of nerve structures, viz : 1st, the 
spinal ganglia, in addition to the ganglionic masses, in connec- 
tion with roots of nerves on either side ; 2d, compound fibres 
bringing these special ganglia into intimate connection — first, 
with the ganglia of the nerve roots ; secondly, with each other.'* 
Any impfession made in the anterior or posterior groups of mus- 



On Physiology and Pathology. 87 

cles, either volitional or reflex, is conveyed to the medulla oblon- 
gata, and thns produces bilateral action of any particular muscle 
or set of muscles co-ordinated by that nerve centre. He says, 
*' this great nerve centre stands in the same relation to the motor 
nerve nuclei of the trunk and posterior limbs, as the corpora 
olivaria do to the muscles of the tongue, face, and throat ;" and 
that the pons varolii stands in a direct relation as to size with the 
power of the animal in maintaining the erect posture and in an 
inverse ratio to the breadth of the basis of sustentation ; as, for 
instance, in the Kangaroo, ^' we find superadded to the single 
median processus vermiformis of the bird, also lateral lobes with 
still superadded lateral appendages." 

Similar views were hold previously by Dr. Andrews, in a report 
on the ^ ^Function of the Cerebellum," made before the American 
Medical Association, and appear in the Transactions for 1858. 
He has gathered from the field of comparative anatomy many 
interesting facts, and has presented eighteen dissections of the 
brain of different animals from the reptile up to man. He says, 
'^ each of the groups of muscles, the posterior and the anterior, 
receives separate innervation, and there is an enlargement of the 
spinal cord in the region where the nerves to each organ run off." 
He concludes, *^ that the lateral lobes of the cerebellum, which 
are properly the posterior, preside over the muscles of the pos- 
terior group, and that the median lobes exert their influence in 
like manner over the anterior group." To illustrate and support 
this theory he makes the following propositions, viz: **1. In the 
warm-blooded animals, the median lobe or vermiform process of 
the cerebellum varies in size directly as the bulk or power of the 
anterior group of muscles ; 2. The lateral lobes vary in like man- 
ner as the power of the posterior group of muscles, subject, 
however, to certain variations." He demonstrates by his dissec- 
tions that the lateral lobes have a marked oorrespondence with 
the size of the brain and the position of the animal in the scale 
of intelligence. 

*^1. If the animal have large complex hemispheres of the 
brain and at the same time very powerful posterior muscles, then 
both these conditions unite in demanding large lateral lobes of 
the cerebellum, and these organs in fact attain under such cir- 
cumstances their maximum development, s. 



88 On Physiology and Pathology. 

^^ 2. If the hemispheres of the brain be of a low grade, but the 
posterior extremities still powerful, then the defioienoj in one 
condition is balanced by the excess in the other, and the animal 
will hare lateral lobes bearing a moderate ratio of size with the 
median. 

<^ 3. If the animal have cerebral hemispheres of decidedly infe- 
rior development, and at the same time posterior extremities 
which are feebler than the anterior, then both conditions will coin- 
cide to rednce the lateral lobes to a balk less than the median." 

He thinks Dr. Carpenter incorrect in aflSrming, that the cere- 
bellum is developed in a direct ratio with the number and variety 
of co-ordinated movements ; and asserts, that it is in direct ratio 
with the quantity and power of the fibres without respect to the 
complexity or simplicity of their combinations. 

The Function of the Spinal or •Accessary JVirve of Willis. — 
M. Claude Bernard has attempted to render more clear and de- 
terminate the origin, distribution and function, of this nerve. 
According to Willis, it is a voluntary motor nerve, and ascending 
into the cranium anastomoses with the pneumogastric, from which 
it borrows fibres, and thus becomes, also, an involuntary motor 
nerve — in fact being an auxiliary of the pneumogastric. In this 
he differs from Scarpa, and other modem physiologists, who hold 
the reverse of this, i. e., that the pneumogastric borrows fibres 
from the spinal. 

Bell and Magendie established experimentally, that the an- 
terior roots of the spinal marrow gave origin to the motor nerves 
and the posterior roots the sensitive nerves. Goeres advanced 
the doctrine that the pneumogastric and spinal sprung from differ- 
ent roots, corresponding to the two roots of a rachidian pair. 
Bischoff supported this view; and Bernard confutes it by first as- 
suming that the origin of the spinal is from a large extent of the 
spinal marrow, while the rachidian arise from a very small por- 
tion, and that instead of its insertion into the fissure between the 
anterior and lateral fascicles, it emerges from the spinal marrow 
near the posterior fascicle. He also contends that the filaments 
of the spinal which anastomose with the pneumogastric, (and they 
do not exceed three or four, ) arise from the medulla oblongata, and 
all the remaining ones which compose the external branch are en- 
tirely distinct from ^ the anastomosis: he therefore concludes. 



On Physiology and Pathology. 89 

that the motor and sensitiye element in tbe spinal nerve is not ac* 
counted for by its anatomical relation to the pneumogastric, nor, 
indeed, by its physiological connection; for he has established 
the truth of the proposition that the recurrent sensibility of the 
spinal is not influenced in the least by a division of the pneumo- 
gastric. 

It presides especially over phonation, and regulates the action 
of the larynx and thorax during the exercise of this ; the pneu* 
mogastric, on the other hand, controls the movements of the oeso- 
phagus, stomach, heart, and lungs, independently of its connec* 
tion with the spinal. Bernard's mode of experimenting was to 
pluck the nerves and roots away as a whole, asserting that the 
function can not be discovered by their section on account of the 
dangerous hemorrhage attending it. In this way he successfully 
destroyed thespinals, and found loss of voice, permanent dilatation 
of the glottis, and inability to contract the vocal cords ; and, up- 
on section of the pneumogastric, he found aphonia, contraction 
of the glottis, and inability to dilate the vocal cords. Tbe con- 
traction and dilatation are not however due to the action of two 
orders of muscles corresponding to the two orders of nerves ; but 
are accomplished through one motor system possessing two func- 
tions, regulated by two orders of nerves distinct in their influence 
and origin. A diversity of function may occur in the same mus* 
cle or group of muscles from a diversity of nervous influence; thus 
at the instant that the larynx is employed in phonatioh by the in* 
ternal branch, the thorax discontinues its function of respiration 
by the external branch of the spinal, and thus assists in the vocal 
effort. While it is therefore anatomically impossible to distin- 
guish perfectly the filaments of these two orders of nerves, it is 
not difficult to discover and prove that phonation is controlled by 
filaments of the spinal, and respiration, circulation and digestion, 
by filaments of the pneumogastric. 

Epilepsy. — The work of Drs. Kussmaul and Tenner, entitled 
'^ Researches on the Origin and Conditions of Epileptiform Con- 
vulsions," contains many worthy considerations on this subject, 
of which we can notice here only those relating to the nervous 
system. He thinks the cause of most epileptiform convulsions 
are a sudden lesion of nutrition in the brain, and are not produ- 
ced by variations of pressure within the encephalon ; that those 



40 On Phjfsiologjf and Paihabgf. 

eoDTQhioDS which are the result of hemorriisge do not proceed 
from the medulla epinalis ; (Brown Seqnard thinka this propo- 
sition incorrect, assuming that the medulla spinalis plays a 
small part in their production ;) that these conTolsions are not 
due to the brain, but to causes found behind the thalami optico- 
rum ; that loss of blood from the brain anterior to the enira 
cerebri cause insensibilitj, unconsciousness, and paralysis ; and 
when occnrriog with convulsions there are alterations posterior to 
the optic thalami; (Brown Seqnard found preriously, that in 
epileptic vertigo the cerebral lobes were ansBmic, and that it was 
enough that the cerebral lobes were deprived of blood while the 
base of the encephalon received too much;) that those resulting 
from hemorrhage are not due to moral or reflex influences ; that 
incomplete epileptic attacks proceed from alterations of the brain, 
while complete attacks are produced by alterations of the entire 
encephalon, and that the spinal cord acts only as the conductor 
of the excitation to the muscles ; that certain kinds of epileptic 
convulsions proceed only from the muscular walls of the vessels 
of the brain, while in others the predisposing cause pervades the 
entire encephalon — at first, occurring in only one part, but after- 
ward the remainder is impaired, whence the attack proceeds ; 
(Brown Seqnard attempted to determine the conditions of this 
predisposition, i. f ., that it did not exist in the cerebral lobes, but 
in parts of the isthmus of the encephalon and part of the cervical 
cord ;) that the medulla oblongata being the origin of the con- 
strictor nerves of the glottis, and the vasomotory nerves, is 
most frequently the point of origin in eclampsia and epilepsy. 

Epileptiform convulsions have for a long time been compared to 
a discharge of electricity from an overcharged battery. Dr. Pid- 
duck in a late paper re-asserts this, and argues that the intermit- 
tance of the paroxysm depends on the accumulation of nervous 
force, during a definite period, in the brain and spinal cord, which 
explodes on the voluntary muscles, thus giving rise to the fit Dr. 
Schroeder Van der Kolk also affirms this position on the premise 
that the ganglionic cells may be considered as batteries. This 
can not be the case, for these cells are joined on one side to fila- 
ments of nerves derived from the brain, and on the other with 
sensitive nerves. Schroeder Van der Kolk thinks that the expe- 
riments of Brown Sequard sustain this position, and that it is by 



On Physiology and Pathology, 41 

reflex irritotion on the brain and spinal cord, that the medulla 
oblongata being the point where reflex inflaences pass to either 
side, that an excitation here prodnces, indeed, all the class of 
general spasms. He examined the medulla oblongata of fourteen 
epileptic patients, nnder the microscope, and discovered~;^r5/, 
hardening or softening ; second, an alteration in the bloodves- 
sels. M. Foville sajs, '* violent muscular action and a want of 
consciousness are the two distinctive marks of epilepsy. He also 
assumes, that the source of these phenomena is reflex excitability 
of the spinal marrow, and of the medulla oblongata in particular ; 
that these centres possess a peculiar capability of determining 
muscular movements independently of volition as the sequence of 
excitations transmitted by them." ^^ In a word, each sensitive 
part of the nervous system, whatever may be each special action, 
is sufficient to determine in the spiral marrow the modifications 
in consequence of which the motor fibres react ;" and that reflex 
action in the spinal marrow may result from peripheric irritation 
and cause muscular action, which is at first local, and finally be- 
comes general in consequence of re-action of the medulla oblon- 
gata. Dr. Todd also occupies this ground, when he says, ^^The 
phenomena of an epileptic fit depend on a disturbed state of the 
nervous force in certain parts of the brain — a morbid excited 
polarity," &c. 

Dr. G. B. Badcliff objects to this position, and contends that 
facts will not justify the assumption that epilepsy is ever due to 
over- action of the brain, for the opposite condition obtains, as in- 
dicated in the state of the circulation and respiration, and from 
post-mortem appearances. He does not think the essential 
cause of these spasms due to an exalted sensibility and activity 
of the ganglionic cells of the medulla oblongata ; that the argu- 
ment in favor of this view is incorrect, viz : that spasm indicates 
over- action, nor that injuries of the spinal cord point to over- 
action of this centre, as assumed by Brown Sequard, for epilepsy 
is not thus immediately produced, but occurs only in three to five 
weeks, when exhaustion has come on ; that these convulsions are 
never due to the presence of stimulus in the venous blood, but to 
the want of arterial blood in the vessels. He agrees with Dr. 
Schroeder Van der Eolk, that the seat of these characteristic 
spasms is to be found in the condition of the medulla oblongata^ 



42 On Physiology and Paihohgy. 

and that this position is supported by the bilateral character of 
the fits, by the post-mortem appearances, and by the fact that 
they commence in the muscles springing from the medulla oblon* 
gata. We regret that space will not allow a more lengthy re- 
view of these learned papers. 

JVervous Influences determining the Color of Blood in Olan* 
dular Organs. — ^M. Olaude Bernard has proven that glandular 
venous blood and muscular venous blood present changes of 
color diametrically opposite when in action or repose. In mus- 
cular function or activity the venous blood is very dark, but 
when a gland is in function or activity the venous blood flowing 
from it is of a bright, arterial, color ; also, when a muscle is in 
repose the blood afforded by it is of a bright- red color, but when 
a gland is in repose the blood furnished is of a black color. 
Now in those glands whose secretion is intermittent the changes 
of color, from red to black, and from black to red, depend on the 
action of two orders of nerves. He explains the manner in which 
these nerves modify and control these chemico- physiological 
changes in the blood. These orders of nerves have separate origins 
and functions, each being antagonistic to the other. He assumes 
that all motor nerves act by either dilating or constringing the 
blood vessels, which position has been denied by Radcliff Hall, 
who contends that there is no such nerve force determining the 
dilatation of these vessels. According to Bernard, these nerves 
act through the influence exerted on the capillary system of blood 
vessels, not by any chemical change exerted upon the corpuscles 
of the blood as there is no anatomical continuity, but by mechan- 
ical conditions retarding or accelerating the circulation ; in the 
former case, the blood is retained in connection with the disinte- 
grating tissues, and thus receives the discoloring elements ; while 
in the latter, the circulation being rapid, the blood is of a 
florid, arterial, hue. His experiments were performed upon the 
sub-maxillary gland of the dog. He found upon excitation of 
the nerve, determining the respective conditions, the blood was 
red or black. When the nervous influence causing the flow of 
arterial, scarlet- colored blood predominated, this phenomenon was 
always present ; and when the antagonizing influence preponder- 
ated, the blood was of a dark-venous color. The intensity of 
color, in either case, is determined by the activity of the nerve in 



On Phyriology and Pathology. 48 

fanction ; for the quiescenoe of one nerve inflaence does not cause 
the color of the blood, but the preponderating action of the other 
nerve, in fanction. The nerves regulating these changes in the sub- 
maxillary gland are the tympano-lingual, and branches of the 
great sympathetic nerve ; the former nerve causing the blood in 
the vein of the sub- maxillary gland to be red, and the latter 
causing it to be black. 

If these positions of Bernard be established, the question as to 
the physiological action of stimulants and sedatives on the ner- 
vous system becomes very interesting. The somewhat mysterious 
action of stimulants in controlling passive hemorrhages and re* 
lieving congestions, is the underlying principle of Dr. Todd's the- 
rapeutics. These remedies act first upon tho nerves of sensation, 
and afterward, if pushed too far, on the nerves of motion. This 
may, in part, explain the modus operandi of chloroform and 
alcohol in preventing and relieving congestions, and modifying 
even acute inflammations. Chloroform when inhaled almost im* 
mediately affects the nerves of sensation, and when pressed con- 
trols the heart's action, and blood vessels ; thus allowing the action 
of the motor nerves to predominate. The result of this is to hasten 
(if the position of Bernard be true) the blood from the parts un- 
der the influence of the sensitive nerves, and to prevent the nor- 
mal supply of blood to the part. This may also explain the fact that 
the adminietration of chloroform and alcohol, in the clinical obser- 
vations of Dr. Todd did not produce congestions, nor increase in- 
flammatory processes. Dr. B. Brown, of North Carolina, reports 
a case of ^' severe laceration and destruction of a portion of the 
brain," which beautifully illustrates the action of anaesthetics (he 
used chloroform and sulphuric ether) on the circulation of this 
organ; he says, ^' hemorrhage, which had been free previously, 
ceased almost entirely after the full ansssthetio impression had 
been produced." ^^ When the anaesthetic influence began to sub- 
side the surface of the brain presented a florid and injected ap- 
pearance ; the hemorrhage increased and the force of the pulsa- 
tions became much greater." This fact confirms the opinions of 
Dr. Todd. The same conditions result from their internal admin- 
istration, only in a modified degree. We may, therefore, safely 
conclude, that Claude Bernard's views, regarding the action of the 
two orders of nerves over glandular and muscular movements, 



J 



44 On Physiology and Pathology. 

point in the way of real progress ; also that the nervous system 
determines more or less the intensity of the inflammatory pro- 
cess. 

Prof. Watters of this city, whose novel and profound views on 
**Life" and ^'Inflammation/' are well known to the profession, does 
not deny that, through the agency of nerves, inflammation under 
certain circumstances is produced ; but contends that inflammatory 
processes may, and do most frequently, occur independently of any 
special nerve action. The following will indicate his views : he 
says, ** in considering the classes of circumstances which may 
occasion the primary conditions of inflammation, we must not 
leave out the influence of the nervous system. Disintegration to 
a certain extent is regulated through nervous conditions." He 
argues that the constant decay or disintegration of the organism 
demands a continuous, commensurate, nutrition or repair, which 
is essential for the normal condition of all parts of the system. 
All the processes necessary for the maintenance of this equili- 
brium of waste and supply, in their totality, constitute energy, 
force, or power, which philosophers and physiologists have so 
vaguely denominated ^^vital," and are essentially the conditions 
of life, disintegration being the antecedent motor. Therefore any 
alteration in the relation these conditions bear to each other, capa- 
ble of causing their disequilibrium, may produce inflammation, 
among which is a derangement in the function of neives. His 
views on the subject are referred to more at length in another 
part of this report by my colleague. Dr. Baumgarten. 

The researches of H. Snellen, ^' On the Influence of Nerves in 
Inflammation," lead him to the opinion that there is no proof of 
any nervous influence causing the dilatation of the blood-vessels. 
The following is a synopsis of his conclusions : ^< 1. Excitation 
of the nerves of sensibility determines by reflex action the con- 
traction of the blood-vessels of the neighboring parts ; 2. Con- 
traction of the blood-vessels is followed after a little time by 
their dilatation; 8. The nerves of the blood-vessels modify 
nutrition, by acting on the calibre of these conduits ; 4. The in- 
flammatory process does not consist essentially in a modification 
of the nervous influence ; 5. The inflammation of the cornea that 
manifests itself after section of the trifacial nerve, is not the 
direct result of absence of nervous influence in the ganglion of 



On Physiology and Pathology. 46 

Gasserius." He differs from Bernard only in denying a nervous 
inflaence to cause dUataiion of the blood-vessels. 

II. Circulatory and Glandular Systems. 

Action of the Heart. — Although, since the time of Harvey, 
and more especially since the introduction of auscultation by 
Laennec, there have been many observers in the field, and nu- 
merous experiments have been performed in order to investigate 
the action of the heart, the cause of its sounds, and the general 
phenomena of the circulation, differences of opinion still prevail 
among physiologists upon these subjects. 

All observers agree as to its rythmical action, the alternate 
dilatation and contraction of its cavities, and in the fact that the 
contraction of the auricles precedes that of the ventricles in point 
of time, but without any distinct interval or pause between the 
two. With regard, however, to the motion of the heart and the 
changes of shape that it undergoes during: contraction, descrip- 
tions differ widely; some observers describing as the systole what 
others describe as the diastole. Dr. Carpenter describes the ac- 
tion of the heart as follows : ** In the systole of the ventricles, 
their surface becomes rugous ; the superficial veins swell ; the 
corneas columns of the left ventricle are delineated ; and the curv- 
ed fibres of the conical termination of the left ventricle, which 
alone constitute the apex of the heart, become more manifest. 
During their contraction the form of the ventricles undergoes a 
very marked change, the apex of the heart being drawn up to- 
wards its base, and its whole shape becoming much more globu^ 
lar. The movement of the apex however is by no means a mere 
elevation ; for, owing to the peculiar arrangement of the fibres 
of this part of the heart, it is made to describe a spiral curve 
from right to left, and from behind forwards. * * * ^he 
diastole of the ventricles, according to Gruveilheir, has the rapid- 
ly and energy of an active movement, triumphing over pressure 
exercised upon the organ so that the hand closed upon it is open* 
ed with violence." Dr. Halford, who has made many experiments 
and observations, and recently published a work on this subject, 
says, that ^* during the systole, or contraction of the ventricles, the 
base of the heart approaches the apex, the latter at the same time 
is pressed downwards, backwards, and from right to left, de- 



46 On Physiology and Pathohgy. 

scribing a part ol a circle ; the ventricles assuming a contracted 
globular form, descend, describing also a part of a circle, bnt 
passing forwards and from right to left." This description agrees 
with Dr. Carpenter's on the whole, but differs from it in that Dr. 
Carpenter maintains that the base is stationary and the apex is 
drawn upwards, while Dr. Halford says that the base descends 
and approaches the apex. 

Dr. Dalton, however, in his work on Physiology, as well as in his 
more recent lectures on the Circulation, puts forward an entirely 
different explanation. He corroborates the description given by 
Harvey, and maintains ^* that the heart, at the moment of the 
ventricular contraction, elongates — the action of the spiral and 
circular fibres of the ventricles tends to draw the sides of the or- 
gan together at its base, and to shoot out or protrude the apex. 
As the apex starts forward in this way, it strikes against the walls 
of the chest, and produces the impulse or ^shock' of the heart, 
so-called, which is felt externally. It is easy to see that the fin- 
ger, laid upon the^ point of the heart, is lifted with violence with 
every contraction of the ventricles. ♦ * * The next point 
to observe particularly," he says, ^*is the hardening of the 
heart at the time when the ventricles contract. The fibres of the 
heart, like those of any other muscle, grow rigid during contrac- 
tion, and the whole organ assumes a condition of firmness and 
tension. At the same time the organ performs a well-marked 
spiral or rotatory movement upon itself, directed from left to 
right." It will be seen by these quotations how much physiolo- 
gists differ even yet on this subject, as it is very evident that what 
Drs. Carpenter and Halford describe as the contraction of the 
ventricles, is to Dr. Dalton the dilatation. For ourselves, we 
are convinced from observation, as well as reasoning from the 
anatomy of the organ, that Dr. Dalton's description is the true 
one, and that the heart actually elongates during the contraction 
of its ventricles. 

With regard to the cause of the rythm of the heart, opinions 
still differ, and to our mind no satisfactory explanation of this 
phenomenon has yet been offered. The opinion seems now to be 
gaining ground that the first sound of the heart (as heard in 
auscultation) is due solely to the tension of the auriculo- ventricu- 
lar valves, and some experiments performed by Dr. Halford seem 



On Pkynohgy and Pathologff. 47 

to explode ftltogetber the idea of its being eansed by nrascalar con- 
traction. 

Dr. Dalton, in the Oonrse of Lectures above mentioned, gives 
some verj interesting observations on the effects produced upon 
the circulation by suspension of the respiration, which, as they 
differ from the views generally entertained, we will mention at 
some length. 

We believe that the views generally held on this subject, are as 
follows : that when from any cause the respiration is suspended, 
the heart goes on as usual, blood is sent through the pulmonary 
arteries into the lungs, where from want of proper aeration it 
slowly traverses the capillaries, and what little gradually reaches 
die left ventricle is discharged into the aorta. The obstruction in 
the lungs continuing however, these become extremely congested, 
and little blood is able to pass to the left side of the heart, so that 
the right ventricle, auricle, and veins gradually become distended, 
while the left ventricle and aorta are nearly empty. Dr. Watson, 
describing death by apnoea, says: <' The motion of the blood in 
the pulmonary capillaries is also, from the first, impeded, and its 
current gradually retarded, until it stagnates altogether; the 
lungs remaining full, the right chambers of the heart distended, 
and therefore less capable of contracting. Meanwhile the black 
blood flowing more and more tardily and scantily into the left 
chambers, leads, by its unnatural quality as well as by its deficient 
supply, to feeble contractions, and this side of the heart is com- 
paratively empty.'* 

According to Dr. Dal ton's observations on animals, in which 
the respiration had been suspended by woorara, ether, or by 
breaking up the medulla oblongata — the following phenomena 
(which we will give as nearly as possible in his own words) were 
observed. He first noticed that immediately after the suspension 
of the respiration, the l^t side of the heart became distended as 
well as the right, or, if anything, the left more than the right. On 
the right side the auricle and ventricle become distended nearly at 
the same time, but the ventricle, if anything, rather the first, and 
on the left side the ventricle and auricle enlarge before the veins, 
while the pulmonary artery enlarges before the pulmonary veins 
and the left auricle. Everywhere the ventricle swells before the 
auricle, the auricle before die veins, and the great arteries lead- 



48 On Physiology and Pathology. 

ing from the heart swell before either. The following is the 
order in which the changes are observed : At first, there is a very 
slight swelling of the cavities of the heart, which takes place 
almost immediately after the stoppage of the respiration. At 
this time blue blood begins to pass through the capillaries of the 
lungs and to appear in the left side of the heart. The venous 
blood thus passes into the left auricle ; from the left auricle into 
the left ventricle ; from the left ventricle to the aorta, whence it 
is distributed to the arterial system. As soon as the blood has 
fairly found its way into the arterial system there begins an exces* 
sive distention of the cavities of the heart, but preceded by a die • 
tention of the arterial system and the aorta. These become en- 
gorged because the venous blood which they contain, arriving at 
the capillaries, is not fit to circulate through them. It hence 
stagnates here, or at least becomes excessively retarded, and be- 
gins to exert a backward pressure on the arteries. The aorta 
sometimes becomes distended to one fourth more than its original 
diameter ; and at the time the aorta is so enlarged there is no sen- 
sible distention of the venae cavse in the neighborhood of the heart. 
Finally, the heart's action becomes labored and spasmodic, blood 
is driven forcibly into the aorta, but owing to the already exces- 
sive distention of the latter it regurgitates into the ventricle, and 
as the heart's action becomes gradually weakened, there is merely 
a flux and reflux of the blood between the aorta and ventricle 
with each contraction. There now occurs another change; when 
the heart is no longer able to drive the blood into the aorta, the 
elastic force of the arteries comes into play, and forces the blood 
from them through the capillaries into the venous system. ,The 
aorta and other arteries thus gradually become emptied and re- 
turn to their former diameter, the heart meanwhile still continu- 
ing to beat feebly. At the moment of death, accordingly, when 
all action of the heart has finally ceased, the arteries are empty, 
or nearly empty of blood, and the ven» cavae in the vicinity of the 
heart are moderately engorged. The auricles and ventricles are 
distended with blood, rounded and bulging in shape, elastic and 
fluctuating to the touch. After death, however, another change 
takes place. A post-mortem contraction of the heart occurs, 
which is especially powerful in the left ventricle owing to its 
greater muscular development. This is the rigor mortis, similar 



On Physiohgy and Paihohgy. 49 

to that in other parts of the body except that it is established 
much more promptly. The effect of this is to dri?e the blood con- 
tained in the left ventricle into the aorta, and the arteries force it 
on as before, and the great veins of the chest and abdomen thus 
become the receptacles of the blood after death. This engorge- 
ment of the veins and the right side of the heart is always ob- 
served after death from apnoea ; but we think that their cause has 
not hitherto been properly understood and explained. 

Jiction of Olands. — In a recent course of lectures delivered 
by M. Bernard on the * ^Experimental Physiology of Digestion,'' 
the following points appear deserving of a special notice. 

Commencing with experiments and remarks upon the saliva and 
the salivary glands, he inserts tubes into the parotid ducts of the 
horse and dog, when the following results are observed : At 
the sight of food the saliva flows in a stream from the ducts. 
The secretion itself is found to be alkaline to the test-paper, and 
perhaps as a consequence of this, when a few drops of acid are 
poured into the mouth a flow of saliva is readily effected ; whore- 
as, when an alkaline solution is substituted no such result is ob- 
served. When food is put into the mouth, and the animal begins 
to chew, it is observed that the saliva flows merely from the gland 
on that side of the mouth on which mastication is going on, and 
hence, these glands are alternately called into action, accordingly 
as the food is on one side or the other, and during the interval 
the secretion almost entirely ceases. 

The elective action of glands is well illustrated in experiments 
on the parotids. When iodine (solution of iodide of potassium) 
is injected into the veins, it almost immediately appears in the 
parotid secretion, whereas it is only with the greatest diflSculty 
that the salts of iron can reach the saliva. We may, however, 
effect this by combining the two elements, as in the use of iodide 
of iron. When iodid. potassa is administered to a dog, traces of 
it may be found in the saliva for several weeks together ; and Ber- 
nard suggests that this proceeds from the fact that, when taken, 
it is excreted from the parotids, again swallowed, absorbed and 
excreted, and this continues till the whole may gradually be re- 
moved by the action of the kidneys. 

It is stated that every gland has two classes of nerves connected 
with it. To one belongs the property of stimulating the secretion 
Vol.. xn — 4 



60 On Physiology and Pathology. 

pecaliar to the gland ; whereas the second excites onlj the transu- 
dation of water from the blood. The motor nerve, as it is called, 
of the parotid gland, is derived from the auriculo*temporal branch 
of the infer, mazil. division of the fifth nerve. When this nerve 
is divided, secretion from the parotid no longer takes place, not 
even when vinegar, sapid substances, and other excitants are 
placed in the month ; on the contrary, when this motor nerve is 
galvanized there is an increased and abundant flow of aqueous 
secretion. When the sympathetic nerve is divided, no change is 
observed in the secretion of saliva from the parotid ; when the 
cut end of the nerve is connected with a galvanic apparatus, how- 
ever, the secretion is not increased but diminished or even sus- 
pended for a few moments — the character of the secretion re- 
maining the same. This is explained by the fact that excitation 
of the sympathetic causes a contraction of the arteries, and hence 
there is a diminished supply of blood to the gland. 

The submaxillary gland presents the same general nervous in- 
fluence as the parotid, the motor nerve in this case being the chorda 
tympani. The excitation of the sympathetic not only diminishes 
the quantity of the secretion but renders it more viscid. With 
regard to the comparative offices of the salivary secretions, it is 
found that when vinegar is put into the mouth, the saliva from the 
submaxillary gland flows at once ; then that from the parotid 
next, and last of all that from the sublingual gland. It is hence 
inferred, that the secretion of the submaxillary ministers to the 
sense of taste ; the secretion oi the parotid is connected with mas- 
tication, and that of the sublingual with deglutition. 

In his remarks upon the oesophagus, nothing new is given ex- 
cept the statement that, when the pneumogastric nerves are divi- 
ded there is a spasmodic contraction of the cardiac orifice of the 
stomach, which prevents food from passing. The animal opera- 
ted on still feels the sensation of hunger, and eats readily, but 
the food can only pass as far as the cardiac orifice ; here it is ar- 
rested, and after a time it is found that the whole oesophagus 
becomes filled until the food presses on the larynx, and a fit of 
sufi'ocation ensues. 

In the stomach, the same nervous influence is perceived in the 
secretion of gastric juice as was seen in the salivary glands. The 
pneumogastrics are the motor nerves to the stomach ; when they 



On Physiology and Pathology. 51 

are galvanized the secretion flows abundantly ; when the sympa- 
thetic nerre is galvanized the secretion is diminished or arrested. 
It is said that all portions of the mncous membrane of the stom- 
ach do not secrete gastric-juice alike, but that this property is 
restricted to the pyloric portion. 

The biliary secretion takes place during the intervals of 
digestion. While the animal is fasting, it accumulates in the 
gall-bladder and is poured into the duodenum only when food 
reaches the stomach. As soon as digestion begins, the bile flows 
from its reservoir and mixes with the food, but no more is then 
formed within the liver, for this organ now begins to exert another 
kind of activity, and is occupied in producing grape sugar. Ber- 
nard's experiments agree with Schwann's that those animals in 
which the biliary duct is tied, and a fistulous opening established 
between the gall-bladder and skin, gradually become emaciated 
and die. But as opposite results have been obtained by other ob- 
servers, he admits that experiments can not enable us as yet to 
decide whether bile is really a secretion or an excretion. 

In 1848, as is generally known, Bernard announced the discov- 
ery of the formation of sugar in the body from the blood, and 
that the organ which possessed this function was the liver. Sub- 
sequent experiments induced him to modify his views somewhat; 
as he afterwards discovered that the blood was not immediately 
transformed into sugar, but that a substance called by him '^gly- 
cogen," was formed in the liver, and this was subsequently 
changed into sugar. These views have met with much opposi- 
tion, although they are finally pretty firmly established. The 
most recent objection of any weight was made by Dr. Pavy of 
Guy's Hospital, who has performed many experiments, and from 
their results attempts to prove that the presence of sugar is due 
to post-mortem occurrence; that as long as life continues glyco- 
gen only is to be found, and that not till after death does the 
transformation into sugar begin. 

Dr. Harley has recently read a paper before the Royal Society, 
detailing experiments made by himself and Dr. Sharpey, in which 
Dr. Pavy's conclusions are refuted : and it is satisfactorily pro- 
ven that sugar itself is found in the circulation. Great care seems 
to have been taken to avoid all souixes of error, and no time was 



1 



62 On Physiology and Pathology. 

allowed to elapse between the withdrawal of the blood and the 
application of the test, as in the following 

Experiment, — A dog was fed solely on flesh during four days. 
Three hours after the last meal, an ounce and a half of blood was 
drawn from the femoral artery, it being made to flow directly into 
a boiling mixture of water and acetic acid. After the coagula- 
tion and separation of the albumen, sugar was distinctly ascer- 
tained to exist in the fluid. This experiment was repeated several 
times with the same result. 

Dr. Pavy states, that the sudden abstraction of heat from the 
liyer, after its removal from the body, checks the transformation 
of the sugar- forming material, and thereby enables us to act on 
the hepatic substance while in the same chemical condition as 
during life. The plan he recommends is, to destroy a dog by pith- 
ing, and instantly to slice a piece of the liver, and throw it into a 
freezing mixture of ice and salt. In which case, he says, that the 
absence of sugar is almost complete ; and thence concludes that 
the presence of sugar in the liver can no longer be looked upon 
as ''a natural condition ;" but *^is in reality due only to a post' 
mortem occurrence.*' Dr. Horley repeated the experiments with 
the above precautions, and nevertheless constantly found sugar 
present in the blood of the liver. 

Experiment. — ^A dog was fed for 14 days solely on flesh. It 
was then killed, the abdomen instantly opened, a portion of liver 
cut oS* and thrown into a freezing mixture of ice and salt. When 
frozen it was sliced into the boiling mixture, and, on the applica- 
tion of Trommer's test, sugar was found to be present. Forty 
minutes after the death of the animal, another portion of the liver 
was tested, and sugar was found present in larger amount ; thus 
confirming Bernard's statement, that the transformation of glyco- 
gen goes on after the death of the animal. Several other expe- 
riments are given ; but as the result is similar in all cases, we 
think these sufficient to indicate his manner of proceeding, as 
well as the results obtained ; and we will therefore merely give 
the conclusions which he draws : 

1. Sugar is a normal constituent of the blood of the general 
circulation. 

2. Portal blood of an animal fed on mixed diet contains sugar. 



On Physiology and Pathology. 58 

8. Portal blood of a fasting animal, as well as of an animal 
fed solely on flesh, is devoid of sngar. 

4. The livers of dogs contain sugar, whether the diet is animal 
or vegetable. ^ 

5. Under favorable circnmstances saccharine matter may be 
found in the liver of an animal after three entire days of rigid 
fasting. 

6. The sugar found in the bodies of animals fed on mixed 
food, is partly derived directly from the food ; partly formed in 
the liver. 

7. The livers of animals restricted to flesh diet possess the 
power of forming glycogen, which glycogen is, at least in part, 
transformed into sugar in the liver ; an inference which does not 
exclude the probability of glycogen (like starch in the vegetable 
organism) being transformed into other materials besides sugar. 

8. As sugar is found in the liver at the moment of death, its 
presence can not be ascribed to a posi'tnortetn changCi but is to 
be regarded as the result of a natural condition. 

III. General Pathology » 

Modern pathology, in the last deoennium, has evidently been 
assuming a new direction, and entered the path, in which Yirchow, 
with clear eye and steady hand, has taken the lead. It has grad- 
ually discarded, to a great extent, the speculative doctrines of the 
ultra neuro- pathologists, and mitigated orthodox humoralism ; it 
evades the extremes of both, yet without making a compromise 
between them ; vindicating the importance of the tissues and their 
active elements, the cells, yet leaving to the blood and to the 
nerves, truly important tissues — all that is due to them. The 
modem conception that subtracts from the idea of disease all 
that is ontological — the conviction that there exists no pathologi- 
cal entity, no abstract principle of disease, but that the latter is 
only an expression of physiological activity deviated by anomalous 
circnmstances— has laid the foundation to that '^ cellular pathol- 
ogy," which Yirchow has now boldly enunciated. The nervous 
system, as well as the blood, are so constituted and situated, that 
they, transmit to other tissues the causes of disease — an irritating, 
a poisoning or other influence — and have therefore in the eyes 
of neuro- pathologists and extreme humoralists, respectively, ob* 



64 On Physiology and Pathology. 

tained the unenviable renown of being the primary and essential 
seat of disease. Physiological activity, however, resides not in 
the nerves alone, nor yet in the blood, bat is common to all tis- 
sues, and therefore all tissues may and do form the basis of 
disease. 

Bernard^ the celebrated physiologist of France, in a series of 
lectures on Experimental Pathology, {Med. Times tr Oazeiie^ 
I860,) speaks of diseases that are induced by means of the ner- 
vous influence ; others occasioned by means of cataly tical agency, 
and finally, those created by deviations in the process of histologi- 
cal evolution. It is the latter class of cases which we have been 
accustomed so persistently tooverlook, or to explain erroneously. 
Bernard endeavors to draw a perfect parallel between the pheno- 
mena of life in health and disease. He says : '^ We are com- 
pelled to admit the existence of three principal classes of pheno- 
mena within the living body, which, although closely connected 
through reciprocal influence, exist independently of each other : 
1. Nervous phenomena, embracing all the mechanical actions of 
life ; 2. Cataly tical phenomena, embracing the various kinds of 
fermentation ; 8. Histological phenomena, embracing the entire 
results of cellular evolution, or the process of development." 

The greater number of diseases Bernard is ready to attribute to 
the influence of the nervous system, as the following words will 
show : ^' If in the case of an adult in the full enjoyment of all his 
faculties, we ask ourselves, what is the regulating agent, what the 
primum mobile of all physiological actions, we are constrained 
to reply, that its seat is in the nervous system, *(« « * it 
presides over all organic functions, and * * * while it is 
the origin of all the normal phenomena of life, it is also that of 
all pathological action. Fever, itself, that essentially medical 
symptom, can be excited by a more mechanical irritation of the 
nervous system, and the products of inflammation * "* * be 
called into existence in a similar way. It is therefore a fact, 
the perverted state of the nervous system gives rise to a great 
variety of diseases, not only of a general, but also of a local 
character. But there exist in disease an immense number of 
other phenomena, which, at first sight, it appears impossible to 
produce by a simple lesion of the nervous system ; I allude espe- 
cially to the alteration or modification of the fluids of the body. 



On Physiology and Pathology, 55 

which takes place in the course of certain maladies. Now * "^ ^ 
a vast nnmber, if not all, of these morbid changes are still to be 
traced to the action of the nenroas system, and they can be re- 
produced at pleasure," (such as albuminuria, diabetes, etc.) 

Bernard's assertion, that many diseases can be produced arti- 
ficially by irritating or destroying certain parts of the nervous 
system, does not however deny that all these can be produced by 
other means. He states that ^* every disease which gives birth to 
morbid tissue is evidently a perversion of the nutritive function," 
and that the influence of the nerves on this act can not be denied. 
Truly, most local pathological processes can be produced by irri- 
tation through the nerves of the part, — ^but, also, as has been 
found (His, Billroth, Virchow, etc.), by direct irritation without 
the intervention of nerves. 

Fever. — Of whatsoever origin, Bernard {Clinique Europe- 
ennej 1859) declares fever to be produced by some action up- 
on the nervous system onfy ; to consist in a sort of paralysis — 
temporary and incomplete — of the sympathetic nerve. If we cut 
the sympathetic nerve in the neck, the same phenomena are pro- 
duced locally as we see in fever ; by galvanic excitation of the 
nerve, these symptoms are made to disappear entirely. The 
febrile condition is in all respects similar to the state thus artifi« 
cially produced. The cold stage in the commencement of fever 
can be experimentally induced by galvanic irritation of the cen- 
tral end of any spinal nerve. Some transitory cause may produce 
a disturbance of general sensation, then the cold stage is induced 
by reflex action of the sympathetic, and thereupon follows a re- 
laxation of the nervous activity, with consequent increase of cir- 
culation and temperature, etc. : thus Bernard portrays the course 
of fever. 

This theory is combatted by Prof. Schiff of Bern, {Allg. 
Wiener Med. Zfg., 1859,) who is of opinion that the cold 
stage does not necessarily precede the fever, nor is the primary 
condition of it ; it is ascertained, that the cold appears only in 
those parts, the vascular nerves of which do not cross within the 
spinal marrow, while in other parts the temperature is elevated 
from the very beginning. Cold and heat are therefore indepen- 
dent of each other ; but having a common source, their succession 
may be easily explained without supposing the one to be the 



56 On Physiology and Pathology. 

necessary condition of the other. Farthermore, the heat and 
congestion are active states, not the passive results of a paralysis 
of the vasomotor nerves, — ^althongh Schiff does not deny the 
possibility of a pathological increase of temperature produced 
solely by a paralysis of the sympathetic or trigeminus. 

Similar to Bernard's theory is that announced by Handfield 
Jones ; {Brit. Med. Journ.j 1858 ;) some of the principal pro- 
positions of which are these: fever may be caused purely by 
nervous exhaustion ; the nervous power of the cerebro- spinal sys- 
tem may sink extremely without producing fever ; but paralysis 
of the sympathetic nerves is probably essential in all fevers. Jones 
explains the increased action of the heart through weakened action 
of the medulla oblongata or pneumogastric nerve. 

A different opinion is held by Dr. Campbell of Georgia, (Trans. 
Amer. Med. Assoc, vol. x. & xi.,) who considers the cerebro* 
spinal system capable of producing some forms of fever. He re- 
marks, that fevers are caused by aberrated nervous action, and 
the only reliable basis for their classification is by this law ; but 
that, as there are two departments in the nervous system — the 
cerebro-spinal, the normal actions of which are interrupted and 
paroxysmal, and the sympathetic, with the characteristic of contin- 
ued action — so there are two grand classes of fevers, correspond- 
ing in their nature to the peculiarity of each department of the 
nervous system, namely, cerebro-spinal fevers, which are all 
paroxysmal, and ganglionic fevers, all continued. 

Chlorosis, — ^Following the classification of diseases which 
Bernard offers us, who seems to insist upon the nervous system 
being the cause of all functional derangement ; or, in his words, 
of deviation in '^ all the mechanical actions of life," we must no- 
tice in this place a new theory on chlorosis^ recently brought for- 
ward by Maack, {Jirch. f. wissensch. Heilk.j vol. iv., p. 1.) 
The development of this malady in a healthy girl can not be suffi- 
ciently accounted for by the old theory ; the same quantity of 
iron is^introduced with the food now as before ; a want of iron 
can not be the cause. Only the power of assimilating this iron 
so as to form haematine is lost. This however is only the first 
consequence, not the ultimate cause cf the disease; which M. 
supposes to be an insufficiency or want of power on the part of 
the liver to produce sugar ; for inasmuch as the formation of 



On Physiology and Pathology. 67 

h»matine requires sugar, (?) a want of hepatic sagar will prevent 
the production of hsmatine even when a sufficient quantity of 
iron is introduced into the blood. Therefore, also, sugar must 
be a curative agent in chlorosis, as it (honey) is really found to be ; 
and iron, Maack thinks, is efficient only by promoting the glyco- 
genic function of the liver. Chlorosis and diabetes seem to be, 
in their nature, diametrically opposed to each other ; and if we 
found means to produce chlorosis artificially, we would have dis* 
covered the radical remedy against diabetes. Bernard, if he 
adopted this view, must call this disease also a nervous one. 

But Bernard by no means shows himself an exclusive neuro- 
pathist, as might be inferred ; he alludes in his lectures to '^ cer- 
tain affinities in which nervous influence does not appear to inter- 
fere — septic, virulent, and contagious diseases.'' These affec- 
tions, including eruptive fevers and the like, he classes in the 
category of catalyticai diseases ^ ^^ which it is impossible for us 
to produce without having recourse to a special virus.'' The lat" 
ter is always a sort of ferment, that reproduces itself and in* 
duces certain changes in the blood by that mysterious process, 
which for the sake of brevity we name catalysis. 

Dyscrasia and Diathesis. -^The subject of dyserasia and diu" 
thesis is also alluded to in one of Bernard's lectures, (on diseases 
arising from the vitiated development of cells,) wherein he gives 
a general sketch of cellular pathology, which he seems to endorse. 
The perversion of the normal evolution of tissues frequently 
gives rise to diatheses; ^^ sometimes they are the result of a 
profound change in the fluids of the economy ; sometimes they 
originate in the introduction of peculiar poisons, which after hav- 
ing once penetrated into ike system, can in no way be expelled ; 
if there existed, for instance, a poison, which none of our organs 
could eliminate, it is clear that after penetrating into the torrent 
of the circulation, it would nowhere find an issue, and would in 
consequence become the origin of permanent modifications in the 
economy." Bernard agrees with Virchow on this point also, 
that ^^ individuals affected with local cancers are not properly in 
a state of a disease, as long as the organs affected are not alto- 
gether essential to life ;" or, in other words, that cancer primarily 
is a local disease. *'But, when, at a later period, the disintegra- 
tion of the elements which constitute the morbid production have 



68 On Physiology and Pathology. 

poisoned in some measure the whole economy, by pouring into 
the torrent of the circulation fluids impregnated with the noxious 
principle, then, indeed, the affection becomes a gereral complaint, 
and its nature entirely changes. Cancer is not a diathesis in it- 
self ; but the subsequent cachetic state is evidently diathetical." 
These views would confirm the law of Virchow, that every dys- 
crasia is localized, and ^' dependent on a continued introduction 
of noxious substances from certain points" within or without. 

An instance of this kind is given in a theory on the origin of 
tubercle. Toulmin, in a paper to the Harveian Society of Lon- 
don, (Med. Times & Gaz., April, I860,) *^ offered as the proxi- 
mate cause of tubercle in all cases, the breathing of impure air; 
or of air in so small a quantity as to render it impure, especially 
during the night;'' or the partial suppression of cutaneous respi- 
ration, induced by neglect of the culture of the skin. He ob« 
served, that whenever this was the continuous state of existence, 
the result must be a deficiency of oxygen in the red globules of 
the blood ; and as the consequence of this, the deposition of 
plastic fibrin in an incomplete state of oxydation, and therefore 
of organization, and incapable of being ultimately got rid of by 
change of matter ; it consequently remained as an extraneous, 
adventitious substance in the system, offering to the observer all 
the characteristics of tubercle. (The arguments, however, evince 
some deficiency of information as to the histological and chemical 
nature of tubercle.) 

An admirable essay on the subject of tubercle, in which a simi- 
lar, but more precise and elaborate opinion is expressed, has 
been written by Dr. Ellis of Boston, (Amer. Joum. Med. So., 
1860). The substance of the paper the author gives us in the 
following resumSi ^^ It is not a specific exudation; it does not 
exist as such in the blood. The yellow variety is always the re- 
sult of metamorphosis-— of degeneration. It is altogether proba* 
ble that it is owing to a ^ degraded condition of the nutritive ma* 
terial,' which differs from that furnished under ordinary circum* 
stances, ^not in kind, but in degree of vitality or capacity for or- 
ganization.' " In reference to the important question of the rela- 
tion between gray tubercle *and inflammation. Dr. Ellis remarks, 
^'it is possible that as exudations are often the result of inflamma- 
tion, their character may be so influenced by general or local 



On Phyriobgtf and Pathology* 69 

causes, that Hnbercle' is the consequence, when it might never 
have been developed nnder ordinary eircomstances. ♦ « « 
Toberole makes its appearance sometimes with, and sometimes 
without inflammation ; and, certainly, .the recent granalations, 
in most cases, show no signs of an inflammatory origin ; the tis* 
sue in their neighborhood is remarkably healthy. If, therefore, 
they generally or often exist without apparent inflammation, the 
presence of die latter should rather be regarded as a consequence 
and not a cause." 

Inflammation. — The nature of inflammatory processes^ 
finally, continued to be a constant subject of investigation, as it 
is the most general of all pathological phenomena. Histological 
researches instituted in aid of the pathology of inflammation have 
not been wanting in the years just passed. Prominent among 
them are those of Barwelt on the Inflammation and Ulceration 
of Articular Cartilage, (Brit. & For. Medico- Chir. Rev., xxiv.,) 
and on Osteitis, {ibid, zzv.) BarwelPs views on the subject of 
inflammation are essentially those of Virchow ; he arrives at the 
conclusion, that inflammation consists in ^* a series of active chan- 
ges in the cells of any structure,'^ and affirms, that '^ the in- 
creased action occurring in cartilage may serve as the type of 
the inflammatory process in its simplest form." This increased 
action comprises swelling and division of the nuclei and cells, the 
formation of blood cells, which burst and discharge their contents, 
of new cells, and corresponding (secondary) changes in the in- 
tercellular substance. ^^In osseous tissues, we find that inflam- 
mation consists of precisely similar actions to those which consti- 
tute that abnormal state in cartilages ; namely, a superabundant 
growth of the cells of the tissue, which, destroying the intercellu- 
lar substance, become converted into granulation or pus cells, or 
may, by becoming fatty and losing quickly their nutritive action, 
cause the integral death of the dependent tissue. The actions, 
then, of a vascular and a non-vascular tissue under inflammation 
are essentially the same ; and it is singular to observe, that half 
a district supplied by one capillary may be in an early stage of 
inflammation, viz., induration ; while the other half shall be dead, 
necrosed, showing how very little in reality the vascular supply 
has to do with the inflammatory condition." The development 
of pus ceUs^ which Barwell finds to originate in the cells of the 



60 On Physiology and P€Uhology. 

inflamed tissues that he examined, has been inTestigated in many 
other tissues, with the same result, by Buhl^ (Virch. Arch, zvi.,) 
BincffleiscAf (ibid, xvii.,) Burcfchardl, (ibid,) etc. — all of 
whom agree, that the corpuscles of pus take their origin from 
connective tissue (and perhaps epithelial) cells, in which increased 
action is set up. Rindfleisch observed their development, step 
by step, in the cornea ; Burckhardt in the mucous membrane lin- 
ing of the urinary passages, and Buhl found them to originate 
from the epithelial cells of the alveoli of the lungs ; in the latter 
case, mother cells were also met with, — the appearance of which 
made it probable that pus cells may be formed by endogenous 
development, as well as by division. Buhl's observations ad- 
mit of no other explanation, in his opinion, but that '^ the pus 
corpuscles are not formed exogenously in a fluid blastema, an 
exudation, but that they arise from preexisting normal cells, and 
that the mode of development is not only that of nuclear division, 
but also that of endogenous free generation by cleavage of the 
cell contents. Billroth ^ who studied minutely all the details of 
suppuration in many tissues, arrives at the conclusion, (Beitr. z. 
Pathol. Histologic, p. 56,) 'Uhat the formation of pus belongs 
almost exclusively to the connective tissue ; that altogether the con- 
nective tissue corpuscles" (including the cells of bone, cartilage, 
etc.) ^^most rapidly produce new colls by division, and are in 
every respect far more capable of development than the cells and 
nuclei of other tissues." 

Inquiring into the proximate causes of inflammation, the essence 
of which consists primarily in increaeed action of the cellu- 
lar elements, we permit ourselves to notice here, even if but 
in few words, the views of our gifted colleague. Dr. Watters, 
(St. Louis Med. & Surg, Joum., Nov., 1858,) although we are 
aware that the members of this Society are fully acquainted with 
them. Dr. Watters starts with the abstract proposition, that ^^all 
physical phenomena depend upon two primary conditions, Form 
and Motion^^ and deduces therefrom by clear and forcible argu- 
mentation the doctrines : that in the phenomena of life the form 
is given in the peculiarly adjusted living organism, — the motion 
represented by decay ; decay is the vital motor ;" disease, at- 
tended with excitement or depression, consists essentially in a 
disturbed relation between decay and renewal, or oxydation and 



On Physiology and Pathology. 61 

nutrition. '* When the causes of inflammation are considered, it 
is observed that whatever cause tends to produce greater decay 
in a part than takes place in health, tends to produce inflamma- 
tion in that part.^' If decay in any part is suddenly increased, 
it will produce disease, (inflammation,) *^ because it requires 
time to change the action of the whole machinery," — to increase 
renewal in the same ratio. 

The influence of the nerves on the inflammatory process has 
been yery thoroughly tested by Samuel^ (Eoenigsberger Med. 
Jahrb., 1858,) who instituted experiments on frogs and differ- 
ent mammals. He acknowledges, that inflammation in cold- 
blooded animals is of another form than in mammals ; that it is 
characterized in the former especially by stasis, in warm-blooded 
animals by exudation. Electric irritation of the ganglion of 
Gasserius invariably produced inflammation of the cornea and 
conjunctiva, which was determined to be independent of any sub- 
seqaent traumatic influences. The other parts of the eye derive 
their trophic nerves from other ganglia, and therefore did not 
become inflamed. The results of these very valuable experiments 
are condensed by the author in the following : ^'1. Acute inflam- 
mation is a lesion of nutrition, induced by intense irritation of 
cells, tissues, and organs. 2. The irritation can have acted on 
these parts directly, or indirectly, by the influence of their trophic 
nerves. 8. The lesion of nutrition consists in an overtransuda- 
tion (hypercrinie) of plasma from the vessels, increased recep- 
tion of plasma into the tissues, and active new-formation of cells. 
Among other lesions of nutrition it is distinguished by the rapidity 
of its access with the character of danger. (Yirchow.)" 

These sentences will not be found conflicting with the views of 
Br. Watters, as above repeated, if we but translate the word 
'irritation" by ^'disturbed relation between decay and renewal." 
The name '^ irritation" necessarily leads to the assumption of 
^'irritability;" and these terms, in the sense in wbich they are 
here used, have been introdaced by Yirchow, and are defined and 
defended by himself as follows : (Yirch. Arch., xiv. ) 

Irritability is the criterion of every living cell and cell- deriva- 
tive, which is manifested by certain actions the element is made 
to perform by means of external influences. Every irritating 
agency causes a mechanical or chemical change in the affected 



6S On Phyiiology and Paihohgy. 

element. This change is of a purely passive nature, — a simple 
lesion ; it is strictly speaking, the irriktmentumy which causes 
the action of the element, and brings into view the condition of 
^Hrriiatio.^* The irritative action thus appears as reaction 
against the irritating cause, — the preceding external action. 
The term irritation necessarily includes this reaction, and we are 
justified in speaking of irritable parts only so long as we see 
actions performed by them which do not simply belong to the 
extraneous passive disturbance. The activity of a cell is mechan- 
ical or chemical, like that of all bodies, but it is distinguished by 
the peculiar, and at the same time constant, adjustment of its 
particles. Yirchow teaches, that the cell is the bearer of all vege- 
table and animal life ; without denying, that the cell also is com- 
posed of atoms ; without contesting the fact, that the properties 
of the cell itself are the resultant of the properties of its atoms — 
still he regards the cell as the ontological form — the person, as it 
were, of life. The reason of the peculiarity of cell action may 
be an atomic one ; but so long as we are unable to reproduce by 
experiment the arrangement of atoms in cell form, we are con- 
strained to regard it as something typical, and at all events to 
concede, that cell action is an entirely special and unique form 
of mechanical process, the details of which we are justified in dis- 
tinguishing by special appellations. 

Such is a very general and brief review of the leading points in 
the more important labors in physiology and pathology during the 
last few years — a review making no pretension to even an ap- 
proach at completeness, but containing whatever of importance 
and interest we were able, in the short time allotted, to glean 
from the limited supply of recent medical literature which could 
be obtained. 

F. W. WHITE, Chairman. 
E. J. MARSH, 

G. H. B. BAUMGARTEN, 

Committee. 



PART II. 

REVIEWS AND BIBLIOGR APHS. 

ARTICLE I. 

On the Theory and Practice of Midwifery. By Fleetwood 
Churchill, M.D., M. R. J. A., Fellow of and Professor of 
Midwifery and Diseases of Women and Children in^ the 
King and Queen* s Cotlef^e of Physicians in Ireland ; Ex' 
aminer in Midwifery in the Queen^s University in Ire* 
land; one of the Presidents of the Obstetrical Society ; 
•Associate Member of the College of Physicians^ Philadel* 
phiaj U, S.y Src.j ice. With additions ^ by D. Francis 
CoNDiB, M.D., Fellow of the College of Physicians of Phila- 
delphia ; Jiuthor of ^^ a Practical Treatise on the Diseases 
of Children J SfC.^ See. With one hundred and ninety -four 
Illustrations, •tf new American from the fourth corrected 
and enlarged English edition. Philadelphia : Blanchard 
«• Lea. 1860. 

This 18 a sew American edition of a well known and highly 
appreciated work, to which the author has added what was found 
wanting, pruned what appeared redundant, and corrected what 
was vaguely or carelessly expressed. It is unnecessary to say 
more than that it will be found to be a full, clear, and accurate 
exponent of the existing state of every department of midwifery, 
whether considered as a science or an art; in style and arrange- 
ment well adapted to the wants of the student and practitioner. 
In this edition, Dr. Churchill presents very clearly his views on 
the operation of craneotomy, as elicited in a recent controversy 
on the subject, in which he has been engaged, setting forth the 
true grounds of the operation and the circumstances under which 
it is justifiable and proper to resort to it. Dr. Condie, too, the 



64 Bibliographical Notices. 

American editori has added a valuable and interesting paper on 
the *^ Qualifications and Duties of the Monthly JSTurses^^ — a 
subject of no little interest to the practitioner of midwifery, who 
has daily to encounter these indispensable pests of the lying-in 
room — so, however, only for want of the knowledge and a dispo- 
sition to carry out the directions here given. To be had at the 
book stores of our city. 



ARTICLE II. 



«j Manual of •Auscultation and Percussion^ as applied to the 
Diagnosis of Diseases of the Heart and LungSy and to 
Pregnancy. Translated from the French qfil. M. Bakth 
and Roger. By J. H. Pottbngbb, M.D., qf St. Louis. 

The work of Barth and Roger has been so long before the pro- 
fession, and its reputation so well established, that it requires no 
praise at our hands. The above is a translation of the resumS 
and other portions of this work. It is intended chiefly as a refer- 
ence book for students when learning practically diseases of the 
chest, and as such is well deserving of extended circulation. The 
translation appears to be well done, its style is clear and fluent, 
and we have found it quite literal and exact in those portions 
which we have compared with the original. 

We regret, however, that Dr. Pottenger did not translate the 
entire work, as its value would then have been much increased 
for the student and especially for the practitioner. The resumSj 
though complete, is too short and condensed for acquiring a 
thorough acquaintance with the art of auscultation. Dr. Potten- 
ger has inserted also the tables of auscultatory signs from the work 
of Dr. Walsh. M. 



PART III. 

RECORD OF MEDICAL SCIENCE. 



Croup without Croupal Cough. — ^Dr. Gottschalk relates some 
cases to show that while, on the one hand, a cough precisely re- 
sembling that of croup may be present in mere laryngitis, the 
characteristic cough may be entirely absent in true croup atten- 
ded with fatal exudation. 



Theory of Syphilisation* 66 

Remarks on the Theory of Syphilisation. By W. BoBKK, 
Professor of Medicine in the University of Christiana^ 
JVhrway. 

[The following is sot translated because it is entirely new, but 
because it contains all that is known on the subject, stated in a 
common-sense- like manner. — ^W.] 

As syphilis (says the eminent professor) is one of the ques- 
tions of the day, let us proceed to notice the labors relating to it. 

In No. 8, Gaz. Heb., of the present year, (1859,) I published 
a succinct summary of the brochure of Mr. Danielssen on syphilid 
sation, as a curative method of syphilis and spedalskhedj (ele« 
phantiasis. ) 

In that resume I gave my theoretic reflections relative to the 
effect of syphilisation, and there limited myself to giving my un- 
derstanding of the saturation of the organism by the chancrous 
virus, successive inoculations with which produce cure of syphilis, 
and immunity against it for the future. 

In Christiana there have been hundreds of persons cured of 
syphilis by syphilisation. The facts can not be denied ; but how 
explain them is a question as interesting as it is difficult of solu- 
tion. 

When I observed my first cases, and that too with the greatest 
exactness, I judged that syphilisation, in relation to syphilis, pro- 
duced in the organism a disposition analagous to that which vac- 
cination produces in the same organism, in relation to variola and 
its own neculiar disease, that is, vaccina or cow-pox. 

This did not help us much in the understanding of the matter, 
for nothing is known of the manner by which vaccination itself 
operates. 

What we are sure of, and what it concerns us above all to 
know, is the salient fact of immunity which vaccination confers, 
for a long time, against variola and vaccina. This is at least 
what is claimed ; we shall see if it is always true. In a word, 
does this immunity proceed from the impregnation of the organ- 
ism with the vaccine virus, or from the destruction of the dispo- 
sition which this organism possesses to contract variola or vaccina? 
One reason induces me to believe that we have nothing to do here 
with the destruction of an organic predisposition ; namely, the 
children of parents who have recently had variola, come into the 
world without diminution of liability to the affection which their 
parents have already had. But because vaccination takes nothing 
from the organism, does it necessarily follow that it adds some* 
thing to it, and especially that this something is impregnation or 
saturation of the humors with the virus ? I am completely igno- 
rant on this point, but I should be sorry to believe it ; because a 
Vol. XIX — 5 



66 Theory of SyphUisaiion. 

saturation of the organism with a virus mnst be deleterions to 
to the individaal ; therefore, I am inclined to admit that the dis- 

Sosition to contract the disease is averted or remains quiet. It 
oes not appear in the individual, but exists in the body, because 
the offspring of the individual enjoying immunity, receives the 
aptitude to take the disease, and is bom with it, and for immu- 
nity requires vaccination the same as if the parent had not been 
in a state of immunity. 

Three women who had been syphilised gave birth to children 
in which the symptoms of syphilis appeared soon after birth. 
Would this indicate that the syphilis had not been extinguished in 
the mothers ? 

The affirmative is a mere presumption ; for the syphilitic virus 
flows slowly through the organism, and the eflect of the last in- 
oculations continues after the ulcers have disappeared, and the 
patient has left the hospital. It is, moreover, requisite to take 
mto consideration the time elapsed between a syphilisation and 
the moment of subsequent conception. We wait, therefore, for 
time to form a definitive opinion upon this point» and confine our- 
selves now in all that relates to syphilisation, to observe nature 
without preconceptions. 

But let us put the case in its least favorable aspect. Let us 
confess that in respect to the condition of the offspring, we have 
gained nothing over the mercurial treatment. Still we have no 
cause to complain of this, seeing that the parents enioy as perfect 
health as before having constitutional syphilis, and that the off- 
spring may in turn be treated by syphilisation with much more 
benefit than mercurial preparations. 

To anticipate here all which may be said against syphilisation, 
I acknowledge that in the last few days there has been a case of 
relapse, that of a man treated twenty-eight months ago. But 
this man had constitutional symptoms for a year before being 
treated. There are in such cases peculiar obstacles, concerning 
which I will explain my ideas on another occasion. 

I now will give the reasons which lead me to suppose that 
syphilisation operates in a manner analagous to vaccination, and 
not, as many have pretended of late, simply as a derivative, that 
is, by producing ulcers which act as excretories of the morbific 
matter. 

I will not devote any more time to theoretical considerations. 
Neither will I enquire whether there are are other dyscragias which 
are amenable to a similar purification, nor whether there is any 
other malady, which, having gradually penetrated, molecule by 
molecule, so to speak, into the blood, may be withdrawn from 
the latter through the skin in the same manner by derivatives. 
We should consider ourselves supremely fortunate were we able 
by means of cantharides to abstract tuberculosis, elephantiasis, 



Theory of SyphiUsation. 67 

or cancer from the body. Bat, unfortunately, we find ourselves 
in the same condition with regard to syphilis as to these diseases. 
But as we have just said, a truce to all theories, that we may deal 
with facts. I desire to relate what I have collected in a multi- 
tude of obseryations, and then we will decide if there is any rea* 
son in supposing that syphilisation acts in a manner analagous to 
vaccination. 

1. When a person with constitutional syphilis is inoculated 
with the vnms of primitive chancre, simple or hard^ and is con- 
tinually inoculated every three days with the pus produced by 
the ulcer of the immediately preceding inoculation, the result is 
that a period will arrive when the inoculation will produce no ef • 
feet. Is it because the matter has lost all its force 7 No ; since 
if a non^syphilised individual be inoculated with the same matter, 
it produces as much effect as it did in the beginning of the pro- 
cess on the first individual. 

2. If, instead of taking the matter from the last pustule, 
which no longe'f produces any result, we go back a little in the 
series and take it from a previous inoculation, we obtain a specific 
ulcer, and commencing from this new second focus, a new series 
of pustules may be produced in the same manner as before, with 
more or less close resemblance to the first in intensity, etc. 

8. If two persons are inoculated at the same time, they arrive 
at immunity against the further action of the matter in about the 
same period. 

But, if we take matter from one to inoculate the other, and 
vice veraay the matter of the last pustules, which in one case gave 
negative results in one of the individuals, will give positive results 
in the other, and vice versa^ that is, during the progress of two 
or three series of inoculations. 

4. Immunity with respect to a matter occurs at the same pe- 
riod, whatever the number of inoculations made at each time, 
whether one or many. 

5. When the first matter will not produce any result, if we 
take other matter it will give a positive result, but for a series 
of pustulations much less numerous than that of the first matter, 
etc. Thus wo ^et pustules and series of reproductions gradually 
decreasing, until we obtain a result negative in consequences, no 
matter what species of syphilitic matter we use in inoculation. I 
will repeat what I have before said ; syphilitic matter finally will 
produce no more effect than a drop of water. 

Can the facts cited be reconciled with a particular, and, as it 
were, ansdmio state of the skin ? Undoubtedly, we would say, 
that the new matter is more intense, since it is efiicacious when 
the old is so no longer. But can this be afBrmed when we recol- 
lect the inoculation with a matter of an older series, or rather 
when, as remarked above, in two persons inoculated during the 



68 Theory of SyphUixaiion. 

same period with the same species of matter, the matter of one 
must be inoculated into the other in order to produce results ? 

Why, finally, does the case in which three inoculations are 
made at each time, reach immunity no sooner than that in which 
only one is made ? 

Let us now refer to another question which has been the sub- 
ject of much doubt ; that of local immunity. Before I ventured 
to say anything of this, I had observed it in many instances. 
I conceived it so strange, that at first I thought I had deceived 
myself in observing it, or rather, that I should consider it the 
result of accidental circumstances. But, inasmuch as it is a 
positive phenomenon, we must yield to the fact and study it as 
it presents itself. The following is what I have observed in re- 
gard to this question : 

1. When one region of the body has been inoculated to immu- 
nity, the matter which will no longer affect this part will produce 
a positive result in another portion of the body. 

2. But the effect produced in the latter part will be weaker 
than if the matter had been primarily inoculated in this portion. 

8. As to the influence which an inoculation has upon the entire 
body, it is nat indifferent whether one part or another is inocu- 
lated. When repeated inoculations have been made in the thigh, 
even to complete immunity of the latter, the result thereafter ob- 
tained by inoculating the arms or sides is insignificant. When, 
on the contrary, we hegin with the arms or sides, a subsequent 
inoculation of the thighs produces marked results, but, neverthe- 
less, not so much but that the influence of the anteriof inocula- 
tions of the arms or sides over the whole body may easily be 
recognized. 

From this we see that the local immunity, far from furnishing 
an objection against the influence of syphilisation upon the or- 
ganism, on the contrary, serves to confirm our belief in its reality. 

'^ But it is objected that this does not conform with what has 
hitherto been understood by the word immunity ; nor with what 
has been considered as constituting the true principles of physi- 
ology ; this logic is inadmissible, say the opposers." The exam- 
S'es to which I have referred are, nevertheless, strictly true, 
ature loses none of her rights ; and it is as certain that there is 
a reason in reference to syphilisation as to every thing else ; but 
it remains to be seen if this fact is entirely unique, or if, on the 
contrary, there are not other analagous facts. At last we have 
returned to the beginning. I do not consider it necessary to go 
further to observe them. We have them, to our notion, in vacci- 
nation. In some children which I have vaccinated in the last few 
years, I inoculated, eight days after vaccination, the matter fur- 
nished by the latter, into the arms and thighs, and sometimes ob- 
tained in the thighs vaccine pustules more or less developed. 



On Turning. 69 

We here have, moreover, the same local immunity, and I see 
with satisfaction, that this phenomenon has recently been observed 
in Paris by M. Goste, who having by accident punctured the ex- 
tremity of the nose with a lancet charged with vaccine matter, 
had upon the part a vaccine pustule, when inoculation upon the 
arms, which he performed at the same time with the same matter 
produced no result. 

It is quite possible that we shall hereafter succeed by means of 
syphilisation, in attaining greater accuracy in our conceptions of 
vaccination ; for in truth all the viruses do not exhibit much dif- 
ference among themselves. It is our duty to ascertain carefully 
their analogies and differences. 

There is another important point in reference to local immu- 
nity. I refer to its duration, which hitherto has been generally 
confounded with its existence. As I have just said, immunity 
may be produced in all individuals ; but weeKS or months after, 
the same individual becomes again susceptible to the impression 
of syphilitic virus. Hence, it is of course possible to produce 
pustules on him again by a primary inoculation. But these can 
never be developed as fully as in the first syphilisation, and it 
will not be possible to produce in this case more than a very lim- 
ited series of pustulations. Thus we see the organism has not 
the same aptitude to the influence of the syphilitic virus as before 
syphilisation. Some time after vaccination the individual may 
have varioloid, and long after, even variola. We do not say that 
after syphilisation the organism will return to the same condition 
as before, and that the virus inoculated will operate with the same 
activity and produce successive series of pustulations equal in 
number and intensity to the first ; but analogy renders the affir- 
mative probable. 

My observations lead me to believe that repeated inoculation of 
primitive syphilitic virus impresses upon the organism a universal 
modification perfectly analogous to that produced by vaccination. 
From all of which I indulge the hope of having found in this 
method a very efficacious auxiliary in the treatment of syphilis, 
and the large number of successes hitherto achieved by means of 
syphilisation assure me that this hope is not chimerical. 

[Pacific Med. Sr Surg. Jour. 



Turning, — ^M. Van Eden advises that in performing the oper- 
ation of turning the child in the womb, the woman should be 
placed on her hands and knees, or, as he calls it, en vachcy and 
for two reasons : the movement of the hand is not impeded by 
the arch of the pubes, and the feet of the child are more readily 
grasped. — Med. Times Sf Oaz. 



70 Treatment qf Skin Diseases. 



On the Iodide qf the Chloride qf Mercury in the Treatment 
of Skin Diseases J and especially of Couperose and Acne. 
By M. Al. Devbbgie. 

This preparation, which possesses very powerfal properties, was 
introduced Dj M. Boutigny, about fifteen years ago, for the treat- 
ment of oouperose, acne, and other skin diseases, which are very 
obstinate, and often irremediable by ordinary means. In these 
cases, it is looked upon by many as a specific; but its chemical 
composition and therapeutical effects have not been studied with 
sufficient accuracy. The action of iodine on protochloride of mer- 
cury was first investigated by Planche and Soubeiran, (Journal 
de Fharmacie, t. xii, p. 651 ;) the product which they obtained 
presenting powerful escharotic properties. By varying the pro- 
portions of iodine and of protochloride, however, different com- 
pounds may be formed ; and chemists have now ascertained that 
the so-called iodide of the chloride of mercury is not a definite 
chemical substance, but is a mixture of the chlorides and iodides 
of mercury, and generally consists of the bichloride and biniodide 
of mercury along with the protochloride. Such appears to be the 
composition of the substance manufactured by M. JBoutigny, who, 
however, keeps his process secret. M. Devergie recommends the 
process of M. Dannecy, as yielding a product similar to that of 
M. Boutigny. Equal equivalents of iodine and bichloride of 
mercury are employed, dissolved in alcohol, which retains a great 
part of the bichloride in solution, and the salt which separates 
(iodide of the chloride) in this case consists of a large proportion 
of biniodide, and a very small quantity of the bichloride, mixed 
with an excess of calomel. Prepared in this way, the iodide of 
the chloride, like that furnished by M. Boutigny, is much less 
violent in its action than either the biniodide or the bichloride 
alone would be in the same dose. 

M. Boutigny employs his preparations externally in the form 
of an ointment, internally in form of pills or syrup. The formula 
of the pommade de Boutigny is : Axunge, two drachms ; iodide 
of the cnloride of mercury, 12 grains — but more recently he has 
increased the proportion of the iodide of the chloride to 16 grs., 
and the ointment, of this strength, is now usually employed. 
The pills contain about one-fifth grain in four pills. 

When applied to the skin, this ointment usually produces, after 
the second or third application, a feeling of heat and smarting, 
which lasts during most of the night if the pommade is used in 
the evening. Next day, if the pain has not been severe, the skin 
is merely reddened ; but if the irritant action has been fully de- 
veloped, the red surface is covered by an immense number of 
minute serous vesicles, which quickly dry up, leaving an epider- 



Treatment of Skin Diseases. 71 

mie crust. In most cases, the inflammation which is ezeitod sub- 
sides rapidly, so that the application of lard or cold cream, for 
four or five days, allows the skin to return to its natural condi- 
tion. Such are the usual results ; but the effects, of course, vary 
with the strength of the preparation and the degree of sensibility 
of the skin—circumstances which must be attended to in the treat- 
ment of different cases. M . Devergie's mode of application is 
to spread the pommade, in very thin layers, uniformly over the 
skin, by means of gentle inunction with the point of the finger, 
for about one minute ; this is repeated every twenty- four hours 
for two, three, rarely four days, and then stopped ; the inflamed 
surface is next covered with lard or starch powder for three or 
four days, till the excited action subsides, and the application of 
the ointment is then renewed as before. This treatment is con- 
tinued for five, six, or eight months, or even one or two years in 
case of relapse. It is the general opinion, that to obtain a com- 
plete cure tne application must be repeated till the strong oint- 
ment, containing sixteen grains of the iodide of the chloride, 
ceases to exert any action on the skin ; but M. Devergie considers 
the cure established when the skin is clear of eruption, and the 
ointment produces only a third or fourth of its previous effects. 
It is especially in couperose, a disease always difficult, and some- 
times impossible, to remedy by ordinary means, that the iodochlo • 
ride ointment exhibits the most remarkable effects. When the 
disease has not reached the tuberculated stage, it frequently cures 
it without requiring so long as six or eight months of treatment. 
M. Devergie relates a striking example of this in the case of an 
actor, who, in consequence of intemperance, had his face so 
blotched and disfigured that even with the assistance of paint he 
could not venture to appear upon the stage, and had to give up 
his engagements. In a few months he was completely cured. 
Although the cases are not always so satisfactory, M. Devergie 
strongly recommends the use of the iodide of the chloride in pom- 
made as generally a very successful means for the treatment of 
couperose. In acne, generally, it does not always suit. It suc- 
ceeds least in A. sebacea and punctata ; A. indurata yields most 
easily, and next to it A. miliaris. The acne rosacea does not 
usually require this treatment at all. In all these forms of acne, 
sulphurous baths and other measures are requisite. In mentagra 
and chronic lichen, it is not more successful than other analogous 
remedies ; in lupus and eczema it does not appear to do any good. 
With regard to the mode of action of the iodide of the chloride, 
M. Devergie holds very decided views. He denies entirely its 
specific action, and maintains that it cures by its topical effects 
only, and not by any influence on the constitution. He strongly 
disapproves, therefore, of the internal use of the remedy as quite 
unnecessary, and a& likely to give rise to salivation, and to in* 



72 Chlorqform in JVhiralgia. 

jure the general health. According to hie view, the cure is effect- 
ed locally, by a process of substitution. The iodide of the chlo- 
ride, being a powerful irritant, induces an acute inflammatory 
condition, which takes the place of, and, as it were, substitutes 
itself for, the chronic sub-inflammatory action of the disease ; and 
by changing the mode of vitality of the tissue, promotes a return 
to the healthy state. The application of blisters in chronic in- 
flammation of the skin is a common example of the same princi- 
ple of treatment. Whatever may be the value of this theory, the 
general view is important, that it is merely in virtue of its stimu- 
lant or irritant properties, exerted locally, and not by any specific 
action, that the cure is accomplished. *Finally, M. Devergie ez- 

fresses the wish that in pharmacy some uniform method should 
eadopted of preparing the iodide of the chloride of mercury, so 
that it may be procured always of the same strength, and may be 
introduced into the therapeutics of legitimate medicine. — Bull. 
Oen. de Therap. ; Edinburgh Med. Journal^ Dec.j 1869.-— 
Cleveland Med. Oaz. 



JViw •^pplicalion of Chloroform in JSTeuralgia and in certain 
Rheumatic Complaints. 

[At a meeting of the Medico-Ghirurgical Society of Edin- 
burgh, Mr. Little, F.R.G.S.E., of Singapore, made the follow- 
ing communication, which we reprint from the Edinburgh Medical 
Journal for April, 1860. — Eds.] 

During my residence at Singapore, East Indies, I was at one 
time in the habit of using liquor ammonia to produce an imme- 
diate blister, when instantaneous counter- irritation was thought 
necessary in certain cerebral affections, &;c., apiece of lint soak- 
ed in ammonia being applied to the part, ana covered with oil- - 
silk, when in a few minutes so much irritation was produced as to 
raise a blister. In administering chloroform to my patients, I no- 
ticed that their lips were often partially blistered by it ; and recol- 
lecting the mode of using the ammonia, I thought of trying the 
chloroform in the same way, but found that neither oil- silk nor 
gutta percha tissue would answer. I then used a watch-glass to 
cover the lint soaked in it, and with the best effect. 

The manner of application is to take a piece of lint, a little less 
in size than the watch-glass to be used (which need not be more 
than two inches in diameter), to put it on the hollow side of the 
glass, to pour on it a few drops of chloroform sufficient to satu- 
rate it, and then to apply it at once to the part affected, keeping 
the edges of the glass closely applied to the skin by covering it 
with the hand, for the purpose of keeping it in position, as weU 



Chloroform in JViuralgia. 78 

as of assisting the eyaporation of the chloroform. This may be 
done from five to ten minutes , according to the amount of irrita- 
tion wished for. 

The patient during this time will complain of the gradual in- 
crease of a burning sensation (not so severe as that produced by 
a mustard sinapism), which reaches its height in five minutes, 
and then abates, but does not entirely disappear for more than 
ten minutes. 

To ensure the full operation of the remedy, it is necessary that 
the watch-glass be rather concave, that it be closely applied to 
the skin, and that the hand applied over it be sensibly warm. 
The immediate effect of the application is to remove all local pain 
in neuralgia, and relieve that of rheumatism. 

Its effects on the skin are at first a reddening of the cutis, 
which in some cases is followed by desquamation of the cuticle ; 
but this depends on the part to which it is applied, and also upon 
the susceptibility of the individual. In some cases, if the appli- 
cation is prolonged, a dark brown stain remain^ even for a week 
or ten days, the same effect as sometimes follows the use of a 
mustard sinapism. 

In Singapore, I have used chloroform after this fashion in vari- 
ous neuralgias or the face, in inflammations of the eye and ear, 
in one case of angina pectoris, in several cases of neuralgia af- 
fecting the abdominal parietes, in lumbago, dysmenorrhoea, and 
in pain attending congestion of the ovary, &c. 

Personally, I can testify to its great efficacy in two severe at- 
tacks of rheumatic inflammation of the eyes, in which the pain 
came on periodically about 8 A.M. with such severity that I 
thought the loss of sight itself would be preferable to its contin- 
uance. All other remedies, such as blisters, leeches, opium ex- 
ternally and internally, belladonna, &c., were of no avail in sooth- 
ing the pain ; water, almost boiling, applied by a sponge, giving 
only a little relief. I then thought of this use of chloroform, 
remembering how much it had benefitted my patients in other 
similar affections. The first night, the application of it to the 
temple relieved the pain in ten minutes ; on its return the next 
night, the application again relieved it ; and four times only was 
it required to remove completely the local pain ; allowing, in the 
meantime, constitutional remedies to produce their effect. Since 
my return to this country, I have recommended this remedy on 
several occasions to persons suffering from neuralgia of the face 
and head, and always with the same good effects as in India; and 
the other evening one of my domestics was quickly and effectually 
relieved by it of a painful spasmodic contraction of the platysma 
myoides muscle, which prevented her raising her head from the 
chest. The chloroform was applied as directed, with immediate 
benefit, and next morning she was quite well, though in previous 



74 Area Cebi. 

attacks several days elapsed before relief was obtained. I have 
mentioned this method to several medical men of this city, who 
have found it of great benefit ; and that it may be more exten- 
sively known, is my reason for now bringing it before the pro- 
fession. 

Dr. Eeiller mentioned this plan had been tried with success in 
his wards. 

Dr. Wright had used chloroform for similar purposes , by pour- 
ing it into a bottle containing blotting-paper, and applying it over 
the affected painful part. He has found it sometimes produce 
vesication, and leave a mark on the skin ; but it had been effectual 
in removing pain. 

[Mr. Little has received the following letter from Dr. Sclanders, 
House Physician to Dr. Keiller in the Royal Infirmary. 

Royal Irfirmary, March 14, 1860. 

Ml/ Dear Sir : I have much pleasure in giving you the result 
of my experience in regard to the external application of chloro- 
form in the way proposed by you. Soon after you made me 
aware of it, I saw a friend of mine, who suffered frequently from 
neuralgia of the left forehead. I proposed the remedy to him, 
and with the effect of immediately removing the pain. Owing to 
my having kept it too long applied, vesication ensued. Since 
then he has had no return. 

I have since used it in several cases of neuralgia of the ovary 
and pleurodynia, as also in two cases of rheumatic pains in the 
joints, with marked benefit. 

I am yours truly, 

ALEX. SCLANDERS. 
Dr. Little.] 



Jirea Cefsi. By Prof. Dr. VoN Babrbnsprung. 

Three diseases causing the hair to fall out have been known to 
the ancient physicians : calvities^ deflnvium capillorum^ and 
alopecia^ with its variety ophiasis. The last named is porrigo 
scuieiialay herpes tonsurans^ undoubtedly connected with a 
parasitic fungus. 

Alopecia corresponds to tho modern appellation porrigo de- 
calvansy the nature of which affection is not yet determined. 
Sateman ranged it among the pustulous eruptions ; Sauvage, 
Fuchs, Wilson, and Rayer, explained it by an atrophical condi- 
tion of the hair-roots ; Gazenave by atrophy of the pigment ; 
more recently, Gruby, Kuechemeister and Bazin delineated differ- 
ent fungi which they pretended to have discovered in this affec- 



Experimeniai Pathohgyj Sec 75 

tion. But Hatebinson denies to it all parasitical origin and seems 
to be rigbt in all bis conclnsions. 

One or more circalar bald spots, of varying size, appear on a 
densely baired bead, exposing a smootb, pale skin, without any 
emption. Tbe hairs surrounding such spots are paler and less 
shining than usual, showing partly also a particular swelling 
which precedes their breaking off. The sensibility is greatly 
diminished in tbe bald spots tbemselres. 

The loosened hair is found, under tbe microscope, to have its 
fibres separated, its root diminished and a great fragility imparted 
to it 

All tbe hairy parts of the body, with the exception of the arm- 
pits and genitals, are liable to this disorder. The only cause of 
it is a locally diminished vitality ; the nutrition of the hair being 
impaired, its color is destroyed, its fibres are divided (thus pro- 
ducing the appearance of a swelling) and its root atrophied. A 
disturbed influence of tbe nerves is always followed by a morbid 
condition of the hair, as may be observed in hemiphlegic patients ; 
Hutchinson is therefore right in pointing to internal disorders as 
causing tbe local external affection. Healthy persons never suf- 
fer from it; while it has been observed in tbose affected with 
scropbulosis and rachitis, as well as in patients recovering from 
febrile diseases. 

Tbe treatment ought to be local and general. Irritating but 
not corroding ointments, like the pomade of Dupuytren, may be 
applied; electricity is to be tried yet. Internally cod- liver oil, 
iodide of potassa and sarsaparilla, are recommended. 

\Jlnn. der Chariie zu Berlin. 



Experimental Pathology — Rational Principles of Therapeu- 
tics. — Lecture Delivered at the College of France. By M« 
Claudb Bernard, Member of the French Institute^ and 
Professor of General Physiology at the Faculty of Sci- 
ences. 

Gbntlbmen : We have considered tbe two opposite points of 
view from which medical men regard tbebealing art; one class, 
as we have seen, recognize the existence of a vis medicatrix 
naturae J or healing power in nature, to the influence of which they 
invnriably attribute tbe return of tbe sick to health ; the other 
class, indignantly rejecting this hypothesis, ascribe the honor 
almost exclusively to the medical man of all the cures which hap- 
pen to be effected ; and these two different opinions, it is not diffi- 
cult to foresee, must of necessity become apparent in practice. 



76 Experimental PcUhology^ See* 

The partisans of the vis medieairix naiurm maintain the prin- 
ciple of expectation, while their adversaries have recourse to a 
practice more or less energetic and varied. 

Both parties have, to a certain extent, tmth on their side ; 
though it would be dangerous for medical men to attach them- 
selves exclusively either to the one or to the other opinion. It is 
true, that nature frequently exerts herself in the cure of diseases, 
but her efiforts, often impotent and ill-directed, stand in need of 
the assistance of art. 

It is by means of medicinal agents that man interferes, for the 
purpose of modifying the course of disease ; it is by means of 
medicinal agents that he accelerates or retards its progress ; it is, 
therefore, in^spensable for every medical practitioner who de- 
sires to be unfettered by the trammels of a slavish empiricism, to 
ascertain their precise action, in order that he may be in a suita- 
ble position to use them when an occasion shall present itself. 

But scarcely have we embarked on the consideration of this 
subject, when a new question presents itself, and which it be- 
comes our duty to solve before proceeding farther. What are 
medicines ; and what is the difference which separates them from 
aliments and from poisons ? On this subject the following defini- 
tion is usually accepted: medicines serve to re-establish health; 
aliments serve to support life ; poisons destroy it. 

But we are evidently, in this respect, under the necessity of 
confining ourselves to generalities somewhat vague. Every defi- 
nition which is of too precise a nature, is apt, on that very ac- 
count, to become inexact. Not to spend too much time on this 
point, we will merely say that medicines are foreign substances, 
introduced into the economy there to determine such and such 
phenomena; it is, therefore, the nature of their action which it is 
our duty to specify. We see from this, that all medicines are in 
their nature poisons, the only difference between the two consist- 
ing in the extent of their action ; for they act only in virtue of 
their toxic properties, being naturally substances foreign to the 
economy. Those substances which already exist in the physio- 
logical state in the system are null in their effects, being neither 
useful or otherwise in the re -establishment of health when it is 
deranged. 

We know, however, that chlorine, iron, phosphorus, and many 
other substances, for example, usually employed as medicines, 
already exist in the body ; but they are never found there in a 
state similar to that in which they are exhibited as medicines. 
Phosphorus, in its pure state, is an energetic poison; whereas, 
phosphates are 'found in abundance in the normal condition of 
the body. Thus, therefore, all substances, whether medicinal or 
toxic, are foreign to the system, either by their nature, or in con- 
sequence of the particular form in which they are prescribed. 



Experimental Paihology^ trc. 77 

As the greater part of poisons belong either to the mineral or 
the vegetable kingaom, it is not surprising that medicine borrows 
the greater number of the agents it employs from the one or the 
other of these two. Sometimes these agents are vegetable alka- 
loids ; sometimes they are purgative salts ; sometimes thev are 
metallic salts ; now these different substances, once introduced 
into the economy, exercise on it a perfectly well-defined action; 
the salts of quinine combat the periodicity of diseases ; mercu- 
rial compounds exercise a specific influence over certain virulent 
affections ; how, then, are we to understand the modus operandi 
of each medicinal agent 7 For a long time it was believed that 
the medicinal substance, penetrating to the interior of our organs, 
addressed itself directly to the morbific principle, with a view to 
neutralizing it ; mercury addressing itself to the syphilitic virus, 
acids to the principle which generates scurvy, and alkalies to that 
on which rheumatism depends ; an attempt has even been made 
to treat lead colic by the administration of sulphuric acid to those 
suffering under that affection, with a view to rendering the mor- 
bific agent insoluble, and consequently inert in the body of the 
tissues. These examples will suffice to enable you to understand 
what has been attempted to be realized by the aid of medicines. 

It is easy to prove, by the simplest possible physiological no- 
tions, that this theory is altogether false. It is manifestly im- 
possible to produce the sulphate of lead in the torrent of the cir- 
culation, and it is equally impossible to render the blood acid, 
for the animal dies a long time before the circulating fluid has 
ceased to be alkaline; in fact, in all animals, whether red or 
white blooded, this fluid is invariably alkaline, although it be- 
comes acid spontaneously after death, when the sugar in it be- 
comes changed into lactic acid. 

The chemical combinations which are usually observed to take 
place in our laboratories, can not be produced in the blood, but 
actions of a different kind are readily produced in this fluid ; I 
allude to fermentations. Introduce yeast into the veins, and you 
will see alcoholic fermentation follow in spite of all the condi- 
tions inherent in the vital principle. But fermentations are not, 
as we know, chemical combinations; they are simply actions. 
Yeast does not combine with the sugar, it only decomposes it, 
and herein lies the secret of its poisonous action. 

It will be easy to give you a still more striking example of these 
particular re-actions. We know that amygdaline, a substance of 
organic origin which is found in the bitter almond, has the prop- 
erty, in presence of certain ferments, of undergoing double de- 
composition, giving origin to glycose and hydrocyanic acid. 
Emulsine, the particular ferment which decomposes the amygda- 
line, exists in the sweet as well as in the bitter almond ; but this 
latter alone contains the principle of amygdaline; hence, the 



78 Experimental PcUhologi/y Sre. 

charaoleristio difference, which we know so well, between the odor 
and flavor of these two fniits, which in every other respect resem- 
ble each other. 

Let us now suppose that we inject into the veins of an animal 
either amjgdaline or emulsine separately, no accident follows ; 
bat if we inject these two substances simultaneously into the blood, 
at two different points, more or less distant, the one from the 
other, the animal almost immediately dies, as if struck with light- 
ning; the re- action which brings about the decomposition of the 
amygdaline is effected in the blood contained in the veins ; prussic 
acid has been engendered, and its poisonous effects have not been 
slow in manifesting themselves. Here, then, is a re- action to 
which the presence of albumen, of fibrin, and other substances 
held in solution in the blood, have offered no obstacle — conclusive 
evidence that, in opposing themselves to the ordinary chemical 
reactions, the albuminous substances of the blood act simply in 
virtue of their chemical properties, and do not, in this respect, 
exercise any vital influence. If it were possible, by introducing 
into the blood certain ferments for the purpose of determining 
reactions of an analogous kind, but of a nature not unfavorable 
to health, the medical art would doubtless have availed itself of 
this method of action ; but it is unfortunately impossible to do so 
in practice — ^in fact, ferments are not generally capable of ab- 
sorption ; at least, up to the present time, we do not know of 
any one that can be taken up by the stomach : it would be neces- 
sary to introduce them directly into the blood. The action of 
emulsine on amygdaline again furnishes a proof of this. In- 
ject some amygdaline into the veins of an animal, while at the 
same time you introduce emulsine into the stomach, no reaction 
whatever takes place, for an impassable barrier opposes the pas- 
sage of the emulsine into the blood. But when the two substances 
are simultaneously introduced into the stomach, so that they there 
combine, reaction follows, prussic acid is set at liberty, and the 
animal dies of poison. This is what takes place ninety- nine 
times in a hundred to those who are guilty of the imprudence of 
eating a large quantity of bitter almonds. If, however, half an 
hour should elapse between the ingestion of emulsine and that of 
amygdaline into the stomach of a dog, no accident is observed to 
take nlace ; the ferment digested in the stomach has descended 
into tne intestines, and has lost all its characteristic properties. 
We do not, up to the present moment, know any ferment suscep- 
tible of being absorbed by the digestive tube. 

It is, therefore, impossible to explain the action of medicines 
on purely chemical grounds ; an explanation has consequently 
been sought for by appealing to notions borrowed from the physi- 
cal sciences. It is thus, for example, that an attempt has been 
made to explain the action of diuretics. M. Poiseuille has proved 



Experimental PcUhoiogyy SfC. 79 

that if distilled water flows with a given rapidity in capillary tubes, 
we can, without modifying the conditions of temperature or pres- 
sure, increase or diminish the rapidity of the flow by the addition 
of certain substances. If, for example, we add to distilled water 
a small proportion of hydro- chlorate of ammonia, of nitrate of 
potash, or of some salt of iodine, the flow becomes accelerated ; 
alcohol, the sulphate of soda, and several chlorides, produce the 
opposite effect of this. M. Poiseuille thought that the diuretic 
action of the nitrate of potash could be explained by the increased 
rapidity in the circulation in the capillaries of the kidneys to 
which it gives rise ; while alcoholic intoxication could, he thought, 
be explained by the diminished rapidity of the cerebral circula- 
tion, and might be dissipated by the salts of ammonia, in virtue 
of the acceleration they produce in the movement of the blood in 
the capillaries. In repeating his experiments, whether on indi- 
vidual organs of the body or on living animals, M. Poiseuille was 
able to satisfy himself of the fact ^at the capillary circulation 
was influenced by sundry agents which accelerate or retard the 
flow of water in glass tubes. 

These are not the only examples of this nature that might be 
cited ; for instance, an attempt was made to explain the special 
action of purgatives, which give rise to a very abundant serous 
discharge from the surface of the intestines by the simple prin- 
ciple of endosmose ; it is true the sulphate of soda, and several 
other saline purgatives, possess endosmotic properties in a very 
high degree ; therefore, it cannot be denied tnat in many of these 
cases the reasoning is somewhat specious ; but there are other 
cases, much more numerous, where this augmentation does not 
hold good. Purgatives, for instance, in many cases, present but 
a very feeble endosmotic property, the greater part of the drastic 
kind being derived from the vegetable kiogdom. 

There is a third way in which the action of medicines may be 
understood, and which is more in accordance with physiology. 
It is admitted that there exists in each organ nn elective action, 
which renders it more apt than the others to be influenced by cer- 
tain medicinal agents. The different ways by which a substance, 
introduced into the economy, can escape from it, are, as we have 
seen, extremely variable. Well, then, medicine acts precisely on 
that organ by which it is eliminated. Reasoning thus supposes 
that the medical action is essentially different from the toxic one ; 
such a manner of viewing the question is, however, quite errone- 
ous, as we shall see by and by ; but in order to better discuss the 
theory to which we have just alluded, let us proceed to consider it 
on scientific grounds. According to this hypothesis, the sub- 
stances introduced into the economy exercise on the organs which 
serve for their elimination an action altogether specific, and experi- 
mental physiology furnishes us with numerous examples of this. 



80 Experimental Pathology^ tee. 

Ether, we know, when it penetrates, by no matter what pas- 
sage, into the torrent of the circulation, escapes by the langs ; the 
characteristic odor of the breath proves this. Well, then, if the 
qaantity of ether introdaced into the economy be sufficient to 
bring about toxic effects, we find at the autopsy traces of an ac- 
tion altogether local, which has been exercised on the lungs. 

But, in the case of phosphorus, the fact is still more evident. 
It is generally by dissolving the substance in oil that we obtain 
it in a convenient form for injection into the veins ; and when the 
dose is not of sufficient quantity to produce toxic effects imme- 
diately, recourse may be had to the following experiment in order 
to demonstrate that it is eliminated by the lungs : place the ani- 
mal in a dark room, and you will see flames escaping from the 
mouth and nostrils ; this is the well known result of the pbos* 

Ehorescence of the gases given forth by the lungs. When, after 
aving subjected the animal to this experiment, we kill it, we dis- 
cover in the lungs lesions of the most serious description ; every- 
where their tissues are congested, and a peculiar yellow hepatiza- 
tion is remarked at different points. 

There are, besides, several other examples of a particular ac- 
tion exercised by different medicinal agents on the organs which 
they traverse on making their escape from the economy. Almost 
all the secreting organs are capable of being modified in a particu- 
lar way, by the action of certain substances found in their secre- 
tions. We shall content ourselves by pointing out the influence 
which is almost immediately exercised by cantharides on the uri- 
nary organs. We know, in fact, that such is the sensibility of 
the organs in this respect, that the simple application of the blis- 
ter suffices, in certain subjects, to bring about a very well-marked 
irritation in the entire urinary apparatus. The effects of can- 
tharides are still more marked when the substance is taken into 
the stomach ; it then gives rise to inflammation of the bladder, 
and to acute nephritis, which are not unfrequently followed by 
the abundant production of false membranes, and in some cases 
by accidents of the most serious kind. 

But in this entire series of phenomena we can not recognize any 
other than a purely local action exercised on the particular organs 
affected. At the time phosphorus and sulphuretted hydrogen tra- 
verse the lungs in making their exit from the body, it is found 
that they have lost nothing of their irritating properties ; it is 
not, therefore, surprising that they develope in tne centre of the 
organ itself, which serves for their elimination, an inflammation 
more or less intense. The same holds good as regards canthari- 
des ; this substance in traversing the urinary apparatus, acts as a 
blister on the mucous membrane which lines its internal surface, 
and there determines acute inflammation. — Med. Times 4* Oaz. 



On the Use and Muse of Tobacco. 81 



Sir Benjamin Brobib on the Use and Muse of Tobacco. 

^^ Sir : Having been applied to some time since to join in a 
petition to the House of Commons, that they would appoint a 
committee to inquire into the effects produced by the prevailing 
habit of tobacco smoking, I declined to do so ; first, because it 
did not appear to me that such a committee would be very com- 
petent to aiscuss a question of this kind ; and, secondly, even if 
they were so, I did not see that it would be possible for Parlia- 
ment to follow up by any act of legislation the conclusions at 
which they might have arrived. Nevertheless, I am ready to ad* 
mit that the subject is one of no trifling importance, and well 
worthy the serious consideration of any one who takes an interest 
in the present and future well -.being of society. From these con- 
siderations it is that I now venture to address you the following 
observations. 

" The empyreumatic oil of tobacco is produced by distillation 
of that herb at a temperature above that of boiling water. One 
or two drops of this oil (according to the size of the animal) 
placed on the tongue will kill a cat in the course of a few min- 
utes. A certain quantity of the oil must be always circulating in 
the blood of an habitual smoker, and we can not suppose that the 
effects of it upon the system can be merely negative. Still, I am 
not prepared to subscribe to the opinion of those who hold that, 
under all circumstances, and to however moderate an extent it be 
practised, the smoking of tobacco is prejudicial. The first effect 
of it is to soothe and tranquilize the nervous system. It allays 
the pains of hunger, and relieves the uneasy feelings produced 
by mental and bodily exhaustion. To the soldier who has passed 
the night in the trenches before a beleaguered town, with only a 
distant prospect of breakfast when the morning has arrived ; to 
the sailor, contending with the elements in a storm ; to the trav- 
eller in an uncultivated region, with an insufficient supply of food, 
the use of a cigar or a tobacco pipe may not only be a grateful in- 
dulgence, but really beneficial. But the occasional use of it under 
such circumstances is a very different matter from the habit of 
constant smoking which prevails in certain classes of society at 
the present day. 

^^The effects of this habit are indeed various, the difference 
depending on difference of constitution, and difference in the mode 
of life otherwise. But, from the best observations which I have 
been able to make on the subject, I am led to believe that there 
are very few who do not suffer harm from it, to a greater or less 
extent. The earliest symptoms are manifested in the derange- 
ment of the nervous system. A large proportion of habitual 
smokers are rendered lazy and listless, indisposed to bodily and 
Vol. xrx — 6 



82 On the Use and Muse qf Tobacco. 

incapable oE much mental exertion. Others suffer from depres- 
sion of the spirits, amounting to hypochondriasis, which smoking 
relieves for a time, though it aggravates afterwards. Occasion- 
ally there is a general nervous excitability, which, though very 
much less in degree, partakes of the nature of the delirium ire' 
mens of drunkards. I have known many individuals to suffer 
from severe nervous pains, sometimes in one, sometimes in anoth- 
er part of the body. Almost the worst case of neuralgia that 
ever came under my observation was that of a gentleman who 
consulted the late Dr. Bright and myself. The pains were uni- 
versal and never absent ; but during the night they were espe- 
cially intense, so as almost wholly to prevent sleep. Neither the 
patient himself nor his medical attendant had any doubts that the 
disease was to be attributed to his former habit of smoking, on 
the discontinuance of which he slowly and gradually recovered. 
An eminent surgeon, who has a great experience in ophthalmic 
diseases, believes that, in some instances, he has been able to 
trace blindness from amaurosis to excess in tobacco smoking ; 
the connection of the two being pretty well established in one 
case by the fact, that, on the practice being left off, the sight of 
the patient was gradually restored. It would be easy for me to 
refer to other symptoms indicating deficient power of the nervous 
system to which smokers are liable ; but it is unnecessary for me 
to do so ; and, indeed, there are some which I would rather leave 
them to imagine for themselves than undertake the description of 
them myself in writing. 

*'^ But the ill effects of tobacco are not confined to the nervous 
system. In many instances, there is a loss of the healthy appe- 
tite for food, the imperfect state of the digestion being soon ren- 
dered manifest by the loss of flesh and the sallow countenance. 
It is difficult to say what other diseases may not follow the imper- 
fect assimilation of food continued during a long period of time. 
So many causes are in operation in the human body which may 
tend in a greater or less degree to the production of organic 
changes in it, that it is only in some instances we can venture to 
pronounce as to the precise manner in which a disease that proves 
mortal has originatea. From cases, however, which have fallen 
under my own observation, and from a consideration of all the 
circumstances, I can not entertain a doubt that, if we could ob- 
tain accurate statistics on the subject, we should find that the 
value of life in habitual smokers is considerably below the average. 
Nor is this opinion in any degree contradicted by the fact that 
there are individuals who in spite of the inhalation of tobacco 
smoke live to be old, and without any material derangement of 
the health ; analogous exceptions to the general rule being met 
with in the case of those who have indulged too freely in the use 
of spirituous and fermented liquors. 



On the Use and Abuse of Tobacco. 88 

" In the early part of the present century tobacco smoking was 
almost wholly confined to wnat are commonly called the lower 
grades of society. It was only every now and then that any one 
who wished to be considered as a gentleman was addicted to it. 
But since the war on the Spanish Peninsala, and the consequent 
substitution of the cigar for the tobacco-pipe, the case has been 
entirely altered. The greatest smokers at the present time are 
to be found, not among those who live by their bodily labor, but 
among those who are more advantageously situated, who have 
better opportunities of education, and of whom we have a right to 
expect that they should constitute the most intelligent and thought- 
ful members of the community. Nor is the practice confined to 
grown-up men. Boys, even at the best schools, get the habit of 
smoking, because they think it manly and fashionable to do so ; 
not unfrequently because they have the example set them by their 
tutors, and partly because there is no friendly voice to warn 
them as to the special ill consequences to which it may give rise 
where the process of growth is not yet completed, and the organs 
are not yet fully developed. 

**The foregoing observations relate to the habit of smoking as 
it exists among us at the present time. But a still graver ques- 
tion remains to be considered. What will be the result if this 
habit bo continued by future generations ? It is but too true that 
the sins of the fathers are visited upon their children and their 
children's children. We may here take warning from the fate of 
the red Indians of America. An intelligent American physician 
gives the following explanation of the gradual extinction of this 
remarkable people : One generation of them became addicted to 
the use of the fire-water. They have a degenerate and compara- 
tively imbecile progeny, who indulge in the same vicious habit 
with their parents. Their progeny is still more degenerate, and 
after a very few generations the race ceases altogether. We may 
also take warning from the history of another nation, who some 
few centuries ago, while following the banners of Soloman the 
Magnificent, were the terror of Christendom, but who since then, 
having become more addicted to tobacco smoking than any of the 
European nations, are now the lazy and indolent Turks, held in 
contempt by all civilized communities. 

^' In thus placing together the consequences of intemperance 
in the use of alcohol and that in the use of tobacco, I should be 
sorry to be misunderstood as regarding these two kinds of intem- 
perance to be in an equal degree pernicious and degrading. 

*<The inveterate tobacco smoker may be stupid and lazy, and 
the habit to which he is addicted may gradually tend to shorten 
his life and deteriorate his offspring, but the dram drinker is quar- 
relsome, mischievous, and often criminal. It is under the influ- 
ence of gin that the burglar and the murderer become fitted for 



84 Jinemia from Prolonged Lactation^ 4*c. 

the task which they have undertaken. The best thing that can be 
said for dram- drinking is, that it induces disease, which carries 
the poor wretch prematurely to the grave, and rids the world of 
the nuisance. But, unfortunately, in this, as in many other cases, 
what is wanting in quality is made up in quantity. There are 
checks on one of these evil habits which tnere are not on the 
other. The dram-drinker, or, to use a more general term, the 
drunkard, is held to be a noxious animal. He is an outcast from 
all decent society, while there is no such exclusion for the most 
assiduous smoker. 

*' The comparison of the effects of tobacco with those of alco- 
hol leads to the consideration of a much wider question than that 
with which I set out. In all ages of which we have any record, 
mankind have been in the habit of resorting to the use of certain 
vegetable productions, not as contributing to nourishment, but on 
account of their having some peculiar influence as stimulants or 
sedatives (or in some other way) on the nervous system. To- 
bacco, alcohol, the Indian hemp, the kava of the South Sea Island- 
ers, the Paraguay tea, coffee, and even tea, belong to this cate- 
gory. A disposition so universal may almost be regarded as an 
instinct, and there is sufficient reason to believe that, within cer- 
tain limits, the indulgence of the instinct is useful. But, we must 
not abuse our instincts. This is one of the most important rules 
which man, as a responsible being, both for his own sake and for 
that of others, is bound to observe. Even such moderate agents 
as tea and coffee, taken in excess, are prejudicial. How much 
more so are tobacco and alcohol, tending, as they do, not only to 
the degradation of the individual, but that of future generations 
of our species. 

^' If tobacco-smokers would limit themselves to the occasional 
indulgence of their appetite, they would do little harm either to 
themselves or others ; but there is always danger that a sensual 
habit once begun may be carried to excess, and that danger is 
never so great as in the case of those who are not compelled by 
the necessities of their situation to be actively employed. For 
such persons the prudent course is to abstain from smoking alto- 
gether. — Med. Times Sr Gaz. 



•Anemia/ram Prolonged Laciaticn — Softening of the Brain — 

Death. 

We have recently lost a patient whose case was an unusual one, 
and one of much interest. A woman, aged about thirty years, was 
admitted for anemia, which was verv decided. She was the mother 
of three children, the youngest about four months old. There 
was an interval of but sixteen months between the births of the 



Jlnemia from Prolonged Lactation^ Src. 85 

]ast twOy and she had narsed the elder until within three months 
of the birth of the younger child, so that for six months gesta- 
tion and lactation were both carried on. She was very poor, des- 
titute of all suitable provision for her lying-in, and was left very 
feeble after her confinement. When received at the hospital she 
was very pallid, complained of a buzzing in her head, or, as she 
expressed it, ^^a feeling as if there were a dashing of water in 
the head." Along the jugulars could be heard very distinctly 
the hrtiit de diable. There was frequent but feeble action of the 
heart, but no other symptoms of disease of any kind existed. She 
was given to full diet, and pills of the carbonate of iron and sul- 
phate of quinine. After a few days she complained of sick stom- 
ach, occarring in the morning, and she believed herself to be 
again pregnant. This sickness was limited to the morning, later 
in the day she was able to leave her bed, and on the day preced- 
ing her death was walking in the garden attached to the hospital. 
She was suddenly seized with convulsions, which continued for 
twelve hours, when she died. After death there were found 
minute tubercles on the pleura and on the mucous membrane of 
the intestines, in their very incipiency, and in a condition in which 
they did not appear to have produced any irritation of these struc- 
tures, as was shown during life by the absence of cough or of 
diarrhoea. There was a remarkable thickening of the entire mus- 
cular coat of the small intestine, but no disease of any other 
structure, excepting that pf the brain. This was found coni' 
pleiely softened^ almost diffluent, and of a pale, creamy color. 
The thalamus opticus and corpus striatum were much softened, 
but the ramoUisement was not limited to these structares, but in- 
volved a large portion of each hemisphere. There was no evi- 
dence of meningeal inflammation. Careful search was made for 
tubercles, but none could be detected. Nor could any evidence 
be found of pre-existing inflammation in the substance of the 
brain. This was examined carefully, in mass, and subsequently 
by the microscope. The healthy brain tissue was everywhere 
broken down, but no compound granular corpuscles, or other evi- 
dence of cerebritis, could be discovered. The basilar artery was 
carefully searched for fibrinous clots, and its structure examined 
for osseous or other degeneration, none of which existed, and we 
are compelled to believe that the softening, which could not have 
been cadaveric, was due to inanition, to a want of proper nutri- 
tion, in consequence of the hydraemic condition of tne blood, 
brought about by the prolonged lactation, the gestation, and the 
destitution under which our patient had suffered. 

The periodical remission and exacerbation of symptoms in dis- 
ease of the brain is of frequent occurrence, but it is not a little 
remarkable that such a change of structure of the substance of the 
brain should have existed without loss of motion, or of intellect. 

[Med. Sf Surg. Reporter. 



86 On the Physiology of Digestion. 



On the Physiobgy of Digestion. By Prof. BuscH of Bonn. 

I had the opportunitj of making experiments on digestion npon 
a woman who had been tossed bj a bull, and presented, in con- 
sequence of the accident, a fistulous opening communicating with 
the small intestines. The fistula was so complete that the bowel 
was divided into two perfectly distinct halves. The upper por- 
tion consisted of the stomach, the duodenum, and of a probably 
minute piece of small intestine ; the lower portion was composed 
of the remaining part of the small intestine, the colon, ana rec- 
tum. Through the npper half, the food introduced into the stom- 
ach, as well as the digestive fluids of the latter organ, the liver 
and the pancreas, escaped, no part of them finding their way into 
the lower half. This state of things was therefore favorable to 
the study of the action of the stomach, of the biliary and pancre- 
atic secretions, and also of the intestinal secretions independently 
of the liquids just named. 

One of the firet effects of the pathological state of this woman 
was a considerable loss of flesh, as observed when she came into 
the hospital, six weeks after the accident. Her appetite was, 
however, insatiable, though she was as weak as those animals in 
whom artificial fistulas are made. She was also very drowsy and 
cold ; but this temperature was merely objective, for a thermome* 
ter introduced into the intestine marked a normal heat. All these 
symptoms disappeared when the patient recovered a little strength, 
in consequence of a generous diet. 

She used to swallow an enormous quantity of food without 
feeling satisfied; but by thus eating largely she felt better, though 
still hungry. When the stomach was empty she felt ill. The 
woman was so thin that the coils of intestines could be seen 
through the parietes of the abdomen ; and it was observed that 
their peristaltic movements were as energetic as those of that por- 
tion of the intestine situated above the fistula and open to view. 

As the intestinal secretion or juice was perfectly pure and un- 
mixed with any chyme, which latter all escaped by the fistula, a 
good opportunity was ofi'ered for studying the nature of that juice. 
Prof. Busch found the quantity always small, and tried its e&'ects 
upon protein compounds, starch and cane-sugar, these being the 
first experiments of the kind ever made. The patient was at the 
same time fed by the introduction into the lower part of the intes- 
tine, through the fistula, of beef- tea, beer, soups with flour, meat, 
hard-boiled eggs, &c. Soon after these injections were resorted 
to, she had numerous stools, a circumstance which had not been 
observed since the accident. The evacuations had a well-marked 
smell of putrefaction, without any undigested portions of meat 
or hard-boiled eggs being noticed in them; this being a clear 



On the Physiology of Digestion. 87 

proof that the intestinal jaice acted as a solvent upon the food 
passing through the canal. 

Mr. Busch used to wrap the various substances introduced in a 
piece of muslin, after having carefully weighed them, in order to 
observe the action of the intestinal juice. He noticed that it was 
principally upon starch that this juice exerted an energetic sol- 
vent power. 

An interesting point was to find out what would become of fatty 
matter without Uie assistance of bile or pancreatic juice. Accord- 
ing to expectation, fatty substances passed without being absorb- 
ed, or at least but a very small portion of them disappeared. 

M. Busch also examined the state of the substances which 
escaped by the upper portion ; namely, those which had been sub- 
jected to the action of saliva, the gastric juice, bile, and the pan- 
creatic juice. A very extraordinary fact observed was, the rapid- 
ity with which the alimentary substances escaped. In from fifteen 
to thirty minutes after the ingestion of the food by the mouth, it 
was observed to escape by the fistula; hard-boiled eggs appeared 
in from twenty to twenty- six and thirty- five minutes; cabbage 
took from fifteen to nineteen minutes; meat from twenty- two to 
thirty minutes; potatoes fifteen minutes. When the meal was 
plentiful, complete digestion required from three to four min- 
utes (?). 

The substances which escaped by the upper end of the divided 
canal seemed at first sight to have undergone but little change ; 
they were, however, considerably softened, and the meat present- 
ed both longitudinal and transverse cracks or slits. M. Busch 
thinks that the fluid in which these substances were suspended 
contained no longer any saliva. 

We add a few of the propositions which the author considers as 
proved by the experiments above enumerated : 

1. The peristaltic movements of the intestines are as vigorous 
when the bowels are covered by skin as when they arc exposed to 
the air ; they withstand the pressure of a column of water two 
feet high. 

2. The intestinal tube has periods of rest and motion. 

8. The intestinal juice is secreted in small quantity ; its re- 
action is always alkaline ; and it contains, on an average, 5.47 
per cent, of solid matter. 

4. It decomposes starch and protein compounds. 

5. It changes starch into grape sugar. 

6. It decomposes protein compounds with the phenomena of 
putrefaction. 

7. It does not change cane-sugar into grape-sugar. 

8. Cane-sugar, when wholly absorbed, does not re-appear in 
the urine. 

9. Fat which has not been brought in contact with the bile or 



88 Treatment of Hmmorrhoids. 

pancreatic jaice, is either not absorbed, or, if so, in very small 
quantities. 

10. The first portions of the food introduced into the stomach 
reach the first third of the small intestine, on an average, in from 
fifteen to thirty minntes. 

11. Gane*sugar held in solution disappears almost entirely at 
the beginning of the intestinal canal ; any such cane-sugar which 
reaches the small intestine is changed into grape-sugar. 

12. Unboiled whitc-of-egg is absorbed in the stomach, or the 
first part of the intestine ; the portion which goes beyond has not 
undergone any change. 

IS. Gum IS not changed into sugar : it passes into the intes- 
tine without alteration. 

14. Gelatine becomes dissolved, and loses the faculty of coagu- 
lation. 

15. Traces of caseine in solution are found in the intestine 
after the ingestion of milk. 

16. Fat forms an emulsion with the fluids which find their way 
into the small intestine, when these fluids have an alkaline re- 
action ; the emulsion is incomplete when they are acid. 

17. The mixture of juices in the small intestine has a diges- 
tive action on the protein compounds. 

18. The minimum of the digestive juices, which reach the up- 
per part of the small intestine in twenty-four hours, weighs more 
than one -seventeenth part of the whole body. — •drchiv. fur 
Path. Heilk. — Maryland Sc Virginia Med. Jour. 



Treatment of Hsemorrhoids. By M. Nblaton* 

The Professor, in a recent clinical lecture, makes the following 
remarks : 

^'I was sometime since a great partisan of the actual cautery 
in hsemorrhoids, at least since it could be employed under condi- 
tions formerly impossible. In fact, nothing can be more painful 
than its application. I have seen cauterization employed many 
times by Dupuytren, who first excised the tumor and then cau- 
terized ; but so terrible were the sufi'erings of the patients, that I 
could scarcely have made up my mind to have recourse to it, had 
not the means of preventing pain by chloroform been discovered. 
I have since then frequently had recourse to cauterization with 
the best results ; and if I do not employ it now it is because we 
have at our disposition another operative procedure, which is just 
as good, and which is not painful either during or after its appli- 
cation. I mean ecrasement lineaire. It is usually unattended 
with hemorrhage, and when, as is sometimes the case, there is a 



Treatment of Haemorrhoids. 89 

certain amount of bleeding, this may at once be arrested by a 
powerful hemostatic, the perchloride of iron. The union of these 
two means, then, constitutes an excellent method for the ablation 
of hemorrhoids. 

*^One word about ligatures. All surgeons at the end of the 
last century and the beginning of the present were very fearful 
of applying them, owing to an instance of fatal hemorrhage which 
occurred after the application of the ligature by J. L. Petit. I 
believe I am right in affirming, guided by the case related by 
Amussat, and by those which have occurred in my own practice, 
that these surgeons entertained the most erroneous notions con- 
cerning the results of the ligature employed for haemorrhoids. It 
is an excellent operation, by means of which patients may be 
cured in eight or ten days without any accident ; and, indeed, I 
may place it on the same line with ecrasement lineaire. The lat- 
ter has, however, the indubitable advantage of causing the fall 
of the tumor within a few minutes, although perhaps it offers 
somewhat less security against hemorrhage. 

*' There is one thing to be well borne in mind, viz., that all 
these operations practised in the vicinity of the anus, however 
simple they may be in appearance, may terminate in a fatal man- 
ner. This is a powerful motive for insisting as long as possible 
on palliative treatment, only performing an operation as a last 
resort. Quite recently, one of our leading surgeons applied a 
small portion of Vienna caustic to a hsemorrhoidal tumor, and 
the patient was dead next day ; while in another case, an incision 
made into a fistula scarcely a centimetre in length, was followed 
in a few days by fatal purulent infection. I was myself consulted 
some years since by a man who having acquired great wealth, 
complained bitterly of not being able to enjoy it in consequence 
of a hasmorrhoidal tumor. I advised him to bear with it, but 
some timo after abundant hemorrhages having come on, he en- 
treated its removal. He manifested all the signs of complete 
anaemia. He did not suffer during the operation, but scarcely 
had he recovered consciousness when he complained exceedingly. 
I appeased the pain and all seemed doing well, when on the six- 
teenth day violent shivering ushered in purulent infection and he 
died. The conclusion to be drawn from all this is, that you should 
never operate except when you can not possibly avoid doing so, 
since when you least suspect it you may meet with sinister events 
similar to those just adverted to. 

" One more word with respect to ecrasement lineaire. This 
operation has during some time been frequently resorted to ; and 
it is for this description of tumor it is perhaps best adapted. But 
I ought to inform you that in most cases the operation is badly 
executed. For a short time after its performance the patients are 
delighted, and the surgeon believes that he has attained a splen- 



90 EdUorial. 

did result; but in the coarse of a few months the cicatricial tissue 
contracts, and the patients suffer from an anal stricture. During 
about a twelve- month I have had a great number of patients, who 
have come to me in order to undergo an operation for the relief 
of this unfortunate consequence of removal of hsemorrhoidal tu- 
mors — the stricture sometimes scarcely admitting the passage of 
a quill. It has arisen because not only the mucous projection 
which alone constitutes the disease has been removed^ but also a 
more or less considerable portion of the skin of the orifice of the 
anus." — Brit, Sc For* Med. Chir, Reviews—from Gazette des 
Hopiteaux. — Ibid. 



PART IV. 

EDITO RIAL 



VOLUME THE NINETEENTH. 

We are growing old in the profession, as well as old in years, 
but we will endeavor not to become garrulous. The fact is, we 
have but little to say on this occasion. Having heretofore prom- 
ised more than we have been able to perform, we are very natu- 
rally averse to committing ourselves further in this way. We 
mean, however, to do the best we can, to render the forthcoming 
volume of our Journal both interesting and profitable to our read- 
ers. We shall use our best exertions also to extend our circu- 
lation, believing that by so doing we will benefit the profession as 
well as ourselves. In this we earnestly solicit the aid and co- 
operation of our friends. 

A medical journal is as essential to the practitioner of medi- 
cine, as a newspaper is to one engaged in the ordinary pursuits 
of life ; and yet, as strange as it may seem, we feel persuaded 
that there are multitudes of physicians who do not take any medi- 
cal periodical whatever. Such persons voluntarily cut themselves 
off from all sources of improvement, and are as ignorant of what 
is going on in the world of medicine, as they are of what is trans- 
piring in the empire of Japan. If it were in our power to reach 
all such, we would urge them by all means to subscribe for the 
St. Louis Medical & Surgical .Journal, without delay ; but as we 
can not do this, we must beg each one of our readers, whenever 
meets with a brother practitioner who is not already in the 



Ediioriai. 91 

regular receipt of a medical journal , to act as oar agent, and pre- 
sent our cause, ^hioh is also his cause. This is one way, and 
a very efficient way, to elevate the standard of professional attain- 
ments, and to promote the cause of sound medical learning. 

We take this occasion to repeat, that wo will be glad to receive 
short communications on practical subjects connected with medi- 
cine, from any and all of our readers, and will take pleasure in 
inserting them in our pages. 

I /K fe.ST. LOUIS MEDICAL COLLEGE./ 

The class in attendance on the St. Louis Medical College during 
the present session is larger than it has ever before been. /The \^ 
number is over one hundred and forty/ We may add, also, that they ^ 

are as intelligent and studious a ^t of young gentlemen as we 
ever saw assembled in any medical institution. 



EFFECT OF POLITICAL EVENTS ON OUR EXCHANGES. 

What effect the strange and startling political events which are 
now transpiring in this country will have on our exchanges re- 
mains to be seen. If there is to be a disruption of our govern- 
ment, as at present threatened — and this once united, happy, and 
prosperous country is to be rent asunder, and divided into sepa- 
rate and distinct nations, there may be a temporary interruption 
in the receipt of some of our exchanges until new postal arrange- 
ments can be effected. God grant that this dire event may never 
take place ! We only speak in reference to possibilities, nay, we 
are constrained to say probabilities. It may be, yes, it may even 
be, that what are now domestic, will in a short time become for - 
eign exchanges. Sad thought, dark and gloomy prospect ! What 
then will become of ocr National Medical Association ? Rather 
what will become of our beloved country itself ? The poet tells 
us in reference to other lands, that 

'' MoantaiDS interposed make enemies of nations, 
Which had else, like kindred drops, been mingled into one ;" 

but here we may behold imaginary lines making enemies of those 

whom nature and reason have designed to be one people. But 

we will not dwell on this painful subject, but rather trust that a 

kind Providence will yet avert the dangers which now threaten to 

divide our happy land asunder. 



MEDICAL MISCELLANY. 

Digitalis in Delirium Tremens, — The Med. A; Surg. Repor- 
ter says : ** The article recently copied from an English journal 
on the administration of very large doses oF the tincture of digt* 
talis in delirium tremens has attracted much attention. The 
English officinal tincture is of the same strength as that of tho 
U. S. Pharmacopoeia. A practitioner of this city has informed 
us that he has frequently prescribed the tincture in drachm doses 
during acute inflammations, but the use of tho article in half 
ounce doses in conditions in which the arterial sedative effect is 
not apparently indicated seems extremely hazardous. Yet it is 
claimed thftt the effects of digitalis in inflammatory affections and 
in delirium tremens are exactly contrary. In inflammatory dis- 
ease it subdues and regulates the pulse, whilst in delirium the 
pulse is by it increased in force and fulness. '^ 

: Missouri State Lunatic •isylum. — We regret to learn that 
Dr. T. B. Smith, who has filled the important situation of Super- 
intendent and Physician to our Stato Lunatic Asylum since its 
organization, has been compelled on account of ill health to re- 
sign. For near ten years past Dr. Smith has discharged the 
duties of chief executive officer of this institution with intelligence 
and fidelity, and under his direction it has grown to be one of 
the best institutions in the country — a credit to him and to the 
State. We therefore regret the necessity which has compelled 
him to retire. 

•S Professional way of Settling a Duel, — A Surgeon Den- 
tist of our acquaintance, of undoubted courage, who commanded 
a company of soldiers in a recent military expedition, in some 
way or other, incurred the displeasure of one oE his men. On 
the return of the expedition, when all military distinctions were at an 
end, and the parties restored to a civic level, the soldier who imagin- 
ed himself aggrieved challenged his commander to mortal combat. 
The dentist after reading the war-like document authorized the 
friend of the injured party to say to him, that if he would with- 
draw his challenge he (the dentist) would draw his teeth for 
him the rest qf his life for nothing. The proposition was ac- 
cepted and here the matter ended. 

JVbshville Medical Recorder. — ^Number 1, vol. iii. (new se- 
ries) of this Journal for November, has reached us. It is to be 
issued monthly, and is edited by Professors Abernathy, Maddin 
& Callender, of the Shelby Medical College. 



Medical MisceOanjf. 98 

Secession of Medical Students. — The New York Medical Col- 
leges — or at least some of them, seem to have been in as much 
trouble this winter as their neighbors in Philadelphia were last 
winter, growing out of the restlessness and dissatisfaction on the 
part of the southern students. In the early part of the session 
there was a threatened stampede, which, however, did not take 

I)laoe ; now, however, we learn from the JBoston Journal, that no 
ess than fifty- seven of the students of the New York University 
have decided to return at once to their southern homes. Accord- 
ing to the Medical Times, the cause of grievance is not altogether 
a political one, but grows out of an alleged indignity offered to 
Dr. Aylette, the well known preceptor of a large class of south- 
ern students, by the authorities of the college. This may have 
had some influence, though it is quite evident that thi fons 
et origo of the difficulty is to be found in political agitation. It 
would be far better for southern and south-western students to 
remain at home, and attend their own institutions, rather than to 
break in upon their studies by these annual disruptions. 

Glycerin and Camphor in suppression of the secretion of 
Milk. — Prof. Harris of Savannah states in the journal of that 
city, that having failed in arresting lactation by the use of bella- 
donna, he has resorted to glycerin and camphor with very decided 
success. He uses a saturated solution of camphor in glycerin 
applied by gentle friction over the whole breast, together with a 
flannel cloth wet with the same and laid over the gland — the rem- 
edy to be persisted in for several days. He also recommends the 
same, with the addition of tannin, in cases of sore nipples. In 
our hands the belladonna has usually acted promptly and efficiently 
in such cases, though it is well to have two strings to our bow, 
and we therefore like the suggestion. 

Death of Prof Harris. — Prof. Chapin A. Harris, formerly 
of the American Dental College at Baltimore, and author of sev- 
eral well known works on Dental Surgery, died in Baltimore on 
the 29th of Sept. last, aged fifty years. In his death the dental 
profession has lost one of its ablest members. 

Chloroform in Itch. — ^The Druggist^s Circular says: *'Prof. 
Bock has found the external application of chloroform useful in 
some cases of itch. This substance appears to kill the insect, ^ 
and, moreover, by producing anaesthesia, it relieves the irritabil- p^, 
ity of the skin. M. Bock has never observed any inconvenience 
to arise from the use of chloroform, and the sensation of burn- 
ing, which it produces for a short time, is quite trifling in com- . " 
parison with the intolerable itching caused by the disease." / 



94 Medical Miseettany. 

Prosecution of a Bone- Setter. — ^The Med. & Snrg. Reporter 
Bays : ** A boy at Birkenhead, England, was iniured, and a bone- 
setter was called in, who said that the thigh-bone was broken, 
and accordingly professed to set it. For this he received his fee. 
The boy became rapidly worse and died in a few days. A post- 
mortem examination showed that the bone had never been broken. 
On account of mal- treatment of the case, the coroner's jary ren- 
dered a verdict of 'manslaughter' against the quack." 

Cesarean Section. — ^The American Medical Monthly says: 
*^Frof. B. F. Barker recently performed the Caesarean operation 
at Bellevue Hospital, on account of a contracted pelvis, the ante- 
rior-posterior diameter of the superior strait being only two inches, 
the cafity of the sacrum filled with a bony tumor. The child was 
removed alive, and is now living. It weighed nine pounds. The 
mother died the fifth day after the operation." 

Ventilation of Rooms at JSTight. — ^The following sensible re- 
mark is from Florence Nightengale, which we quote from the 
Southern Med. & Surg. Journal : '^ An extraordinary fallacy is 
the dread of night air. What air can we breathe at night hut 
night air ? The choice is between pure night air from without 
and foul night air from within. Most people prefer the latter. 
An unaccountable choice. What will they say if it is proved to 
be true, that fully one half of all the diseases we suffer from, is 
occasioned by people sleeping with their windows shut? An 
open window most nights in the year can never hurt any one. In 
great cities night air is often the best and purest air to be had in 
the twenty-four hours. I could better understand in town shut- 
ting the windows during the day than during the night, for the 
sake of the sick. The absence of smoke, the quiet, all tend to 
making night the best time for airing patients. One of our high- 
est medical authorities on consumption and climate has told me 
that the air of London is never so good as after ten o'clock at 
night." 

Stramonium in Neuralgia. — From the same source we get 
the following : *' In the Chicago Medical Examiner, for October, 
Dr. A. Young has an article upon this subject. The author says 
of neuralgia: *I have to meet with the first instance that has 
failed to yield to stramonium.' 'The mode in which I have given 
it in the intermittent form, is gr. i. of Tilden's ext. stramon. fol., 
every two or three hours during the intermission, until the system 
is decidedly offected, indicated by dilated pupil, disordered vision, 
vertigo, and often hallucinations, or mild delirium. When given 
to this extent, it will generally be found unnecessary to repeat it. 
Anything less than this will be of comparatively little value.' " 



Medical Miscellany. 9»^ 

Sails in the treatment of Dysentery. — A writer in the Boston 
Med. k Surg. Journal says : ^' Any one disposed to test the value 
of scMs in the treatment of dysentery, as recommended by Dr. 
Jackson in your last issue, may find in the Dispensatories a 
formula for preparing the article, which has long been a popular 
one and has the advantage of being required in a small amount at 
once. The formula is : Glauber's salts, 1 i. ; water, ^ iij. ; nitric 
acid, muriatic acid, da 3 i. ; alum, 3 i. Dose, a large table- 
spoonful. 

I have used it for some years, both in dysentery and chronic 
diarrhoea, and its use has been followed by recovery sooner than 
I have found it to be after any other prescription. 

When the wholesale throwing overboard of drugs shall take 
place, our humane feelings will be comforted by the reflection 
that this medicine, at least, will not be ^worse for the fishes,' as 
sea- water already contains most of its ingredients." 

The Pocket Anatomist. — We have received a copy of this lit- 
tle volume, which purports to be a complete description of the 
anatomy of the human body, for the use of students preparing 
for their examination. If such be the fact, the author has cer- 
tainly succeeded in reducing anatomy to a nut shell. 

Hospital for JSTegroes. — A hospital exclusively for the treat- 
ment of diseases of the negro has been established in Charleston, 
8. C, which is to be open for clmical instruction, thus afi'ording 
southern students an opportunity of becoming practically ac- 
quainted with the diseases of this large and important class of 
patients. This is a good move. 

Baltimore Journal of Medicine^^a new enterprise. — Dr. 
Edward Warren, Prof, of Materia Medica in the University of 
Maryland, and formerly editor of the North Carolina Medical 
Journal, proposes to commence the new year by the publication 
of a bi-monthly journal of not less than one hundred pages, in 
the city of Baltimore, at three dollars a year. Baltimore is the 
only large city in the United States which has not its medical 
organ — we are not surprised therefore at the receipt of the pros- 
pectus. Dr. Warren has youth, energy and talent, together with 
some experience in the life editorial — he is therefore well quali- 
fied for the undertaking — at all events we are willing to underwrite 
for him, and in advance cheerfully extend to him the right hand 
of fellowship. 



96 Medical Miscellany. 

Use of the Sponge Tent in Sterility. — M. Pleiffer mentions, 
in L'Union M6dicale, that Prof. Stoltz of Strasbourg Succeeded 
in removing sterility in the case of a healthy childless couple, who 
had been married lour years. On examination, the cervix was 
found extremely narrow and very rigid. The use of tents of pre- 

Eared sponge for a month or six weeks, with an occasional warm 
ath of an hour's duration, was advised ; and the lady became 
pregnant two months after beginning the treatment. She was 
eventually delivered of a healthy boy. This procedure seems to 
M. Pleiffer preferable to the division of the cervix, as advised by 
Dr. Simpson, especially where the patients object to the use of 
the knife. 

Patent for Ether ^ Inhalation refused. — ^We are glad to learn 
from our Boston cotemporary, that the Commissioner of Patents 
at Washington has refused the application of W. T. G. Morton 
for a further extension of a patent for the exclusive use of ether 
in surgical operations. This is as it should be. Surgeons and 
others can now use this valuable anaesthetic without ttie fear of 
being annoyed by a suit for infringing on patented rights—- which 
has even been attempted in some cases. 

Curious Death. — The following is from the Med. & Surg. 
Reporter : ** Two men in France took shelter in a barn for the 
night. In the morning one of them was found dead, with severe 
injury to the head. The comrade was at once arrested, and told 
some 'cock and bull' story about the terrible storm of the night 
in question, and attributed his companion's death to the effect of 
a thunderbolt. He was not credited, and was in a fair way to be 
executed for the supposed crime. A scientific gentleman, hear* 
ing of the circumstance, examined the place, and found a hole in 
the roof of the barn, and an aerolite close to the spot where the 
deceased had slept on the night in question. The innocence of 
the accused was at once considered as established, and he was 
released." 

Se- appointments. — We have elsewhere announced the resig- 
nation of Dr. T. R. H. Smith as Superintendent of the Missouri 
State Lunatic Asylum, situated at Fulton, on account of ill health. 
We are now pleased to state that Dr. Smith's health has since 
that time materially improved, and that the Board of Managers 
have re- appointed him to his former position. The Board also 
elected Dr. James P. McElhiny of St. Charles to the post of 
Assistant Physician. Both good appointments, and will no doubt 
give general satisfaction. 



THE ST. LOUIS 

MEDICAL AND SUEGICAL JOURNAL. 

Vol. XIX. MARCH, 1861. No. 2. 

PART I.— ORIGINAL COMMUNICATIONS. 

ARTICLE I. 

«tf Case f^ Blighted Fcetus carried to fuO Term. By A. 
W. Rbbsb, M.IX, of Saline Co., Mo. 



Mrs. Maria R , etat twenty-one yean, large, indining to 
enbonpoinij fair complexion^ dark hair and eyes, about the 
middle of the month of March, I860, reqaested me to examine 
and prescribe for her case. She presented the following symptoms, 
headache, thirst, febrile exacerbation ; pulse 110 ; tongue slightly 
furred and red at tip and edges ; the cutaneous surface dry and 
hot. She was the subject of deep* seated pelvic pains, with a 
sense of weight and bearing down in that region. She was also 
disturbed by an acute pain occurring regularly each night, and 
generally towards morning, about the middle of the sacrum and 
extending to the hypogastrium. This was succeeded by an imme- 
diate and urgent desire to evacuate the bowels : after a discharge 
from the bowels, more or less oopious, the pain was removed 
altogether, or in a great measure relieved. This had occurred 
for many nights in succession. She fancied herself the subject 
of prolapsus uteri, and gave me the following history of her 
ease. 

Vol. XIX— 7 



98 Case oj Blighted Fatus. 

Sometime during the preceding fall she had reason to suppose 
herself enceinte. The usual phenomena of pregnancy appeared in 
her person. Arrest of the catamenial flow ; morning nausea and 
vomiting ; areolar discoloration ; capricious and unnatural appetite ; 
strange and uneasy pelvic sensations ; increase of size ; and, to 
crown all, about the latter part of the third month — according to 
her computation — the movements of the fxtus in vtero were dis- 
tinctly felt. All these things led her confidently to suppose that 
she was pregnant. Subsequently, however, in the course of a 
few weeks, all foetal motion subsided. This was succeeded by 
an arrest of development in her person, and there was a decided 
sanguineous discharge. 

These circumstances^-but more particularly the appearance of 
«« the show" — which she supposed to be the return of the men- 
strual flow, led her to think that she had been mistaken as to her 
previous condition. I requested permission to make an examina- 
tion per vaginum. I found the os uteri high up — neither dilated 
nor dilatable — and in its normal position. There was but little 
undue heat or tenderness, either ot the vaginal canal or uterine 
orifice. On performing the ballottementy I discovered that she 
was pregnant. I stated to her my opinion that the uterus con- 
tained a dead/(BtuSy which might be thrown off at any time, or 
possibly might be carried to the full term of utero-gestation. 

I placed her upon iron, a pill of the proto-carbonate, **Vallett*8 
mass," three times daily. She was to take each night at bed- 
time a powder of the sulph. morphia. The bowels were to be 
kept in a soluble condition by mild laxatives, as puivis rhei and 
carb. magnesia, sodae, phosph., &;c., &c., and during the febrile 
excitement she was to take the effervescing draught of the U. S. 
Dispensatory. She was also to take gentle exercise in the open 
air to the extent of her strength in pleasant weather, avoiding all 
disturbing influences, mental, moral, and physical, as likely to 
exert an unfavorable influence upon her case. 

Time passed on with variable states of health in this patient. 
Sometimes there was a great deal of suffering, and again, she 
would enjoy comparative comfort and ease. Much of the time, 
however, she was troubled with uneasy pelvic sensations, amount- 
ing sometimes to positive pain — with disturbance of the digestive 



Case of Blighted FoUus. 90 

organs, extreme nanaea. and Yomiting — and diarrhoea alternatiDg 
with ooQStipation ; she lost flesh, hot suffered no extreme emacia^ 
tion. 

On the night of the 14th July, 1860, at 11 o'clock, I waa 
summoned to attend this lady in her confinement. There was 
nothing strange or nnnsaal in the labor itself. The ^^paina'' 
came on regularly, and the gradual dilatation of the os uteri re- 
vealed to the touch the ^'membranous pouch" protruding through 
the orifice. Through these, I discovered presenting the inforior 
extremities of a small foetus. 

In two hours and thirty minutes the labor was safely concluded-* 
a foetus, with the placenta and membranes entire, was expelled — 
there was not the slightest hemorrhage, and the womb contracted 
well. On inspection, Uie products of the labor proved to be a 
small foetus of about the third month. It was in a fine state of 
preservation, but presented a strange unusual appearance. It 
was shrunken, shrivelled — somewhat corrugated — and looked as 
if it had been soaked in ^4an ooae'' for a long time. The mem^ 
branes were dense and tough, and on tearing them open they were 
found to contain a small quantity of dirty-colored, inodorous 
liquor amnii. A portion of the uterine surface of the placenta 
appeared to have been detached for some length of time. 

The lady made a fine recovery, and has since enjoyed excellent 
health. I omitted to mention that this was her second labor. I 
attended her, eighteen months previously, in her first confinement. 
The labor was a natural one, but was slow and painful ; it was 
complicated in the third stage by retention of the placenta, from 
hour-glass contraction of the womb. I had to remove the pla- 
centa by introducing my hand into the lower compartment of the 
uterus, dilating the stricture ; gaining access to the upper, and 
allowing the contractions of the uterus, excited by the presence 
of the hand, to expel placenta and all together. This was effect- 
ed without hemorrhage or distress to the patient, as she was pro- 
foundly under the influence of chloroform during the operation. 

Some interesting, and perhaps practical, deductions may be 
derived from observation of such cases as these. What is their 
relative frequency and importance in the great field of obstetric 
science? and what is the oflBce of the accoucheur in their conduct? 

During a long course of obstetric practice, in which almost 



100 Owe of BHgUed FcUua. 

eveTj form and variety of abortion and misearriage have come 
under mj professional care, bnt few cases of this precise descrip- 
tion have been met. Yet that they are not infrequent I am 
aware. The ^'books'' contain occasional allusions to such. Dr. 
Miller of Louisville^ Ey., in his late admirable work on ^^ Obstet- 
rics," records such facts; and in the course of my general ob- 
stetrical reading I have met with recorded instances of great in* 
ieresty both in a scientific and novel point of view. 

My friend, Dr. Thomas of St. Thomas, Mo., gave me the 
details of two interesting cases of this sort that came under his 
professional superintendence some time since. In one of these 
patients the general health was unimpaired ; the other suffered 
great inconvenience and distress during the period of gestation. 
A still more curious and instructive case was related to me by 
my friend. Dr. Wm. M. Belt of Independence, Mo., and by him 
reported in the Amer. Jour, of the Med. Sciences for 1865. 

That the diagnosis in such casra is often obscure, and some- 
times extremely difficult, may be well imagined ; and the impor- 
tance of arriving at correct views and conclusions can not be too 
highly estimated, both as to the reputation of the medical gentle- 
man who has charge of the case, and the comfort and safety of 
the patient confided to his care. 

Among the dangers and accidents to which parturient women 
are most obnoxious, abortion and its confrere^ miscarriage, stand 
most prominent. •Sbortion is, in fact, the great evil to which 
pregnant females are most liable ; and it is a result to be dreaded 
and avoided by all possible means, therapeutical and prophylac- 
tic. It is a termination of conception and impregnation that 
nature abhors j and she therefore throws about the patient every 
safeguard and every means to prevent a calamity so dire. Mis- 
carriage, though perhaps less disastrous in its constitutional 
effects, is still an evil of too great magnitude, both in its imme- 
diate and ultimate results, not to be deprecated and most care- 
fully avoided by all the means in our power. This, the voice of 
nature, and of reason too, alike proclaim ! Hence, though the 
foetus itself may perishj the vital attachments of the placenta 
remain, and the uterus, loth to deliver up the precious fruit en- 
trusted to its care, guards its portals with a jealous care ; and 
the fostus shut up, as in a mare elausum^ from the outer world, 



Case qf BUghted FoOum^ trc. 101 

and floating in a liquor amnii, that in the chemistry of Nature's 
wondrous crucible becomes imbued, perhaps, with anli'Sepiic 
powers, is borne in triumph to the full term, and deliyered in 
harmony with Nature's matchless^ plan ! 

Now what shall the man of physic do when such cases present 
tbemselTee for treatment at his hands ? Shall he enact the part 
merely of an idle spectator of the scene, or shall he bring to bear 
the resources of his art? In the main, I opine, his treatment 
can but be palliaiive at the best. The patient he must keep 
* 'under strictest ward and watch." He must nerer lose sight, 
for a moment, of the critical nature of the ease. Uterine irrita- 
tion, pain, and ^'nights de?oid of ease," must be subdued. Many 
remedies there are '* whose praises have been sung ;" but opium 
is ^Uhe kingy^^ whose magic sceptre soothes the weary, aching 
frame, and scatters care away ! It is 'Hhe sweet, obliFious anti- 
dote" that brings balmy sleep and peaceful dreams. It is the 
''kind nepenthe" which, like the charmed chalice of the gods, 
sparkling with its lethean draught, wafts the weary sufferer from 
his coach of pain and care to scenes of blissful ease ! Is this the 
poet's dream, or is it the experience of a thousand years ? 

Give your patient, at bed-time each night, a morphine powder, 
or an injection of starch and laudanum I If she be of a san- 
guineo* nervous temperament — and, withal, if she be inclined to 
plethora — deplete moderately : if she be tenemiCy give her iron, 
''Vallett's mass," the ferri citras, the iron by hydrogen — or, 
what is as good as anything else, the old ferri sulph. made into 
pills with the soft ext. gentian. If there be febrile symptoms, 
thirst, hot skin, &c., give the effervescing draught ; or, what is as 
good, a solution of ant. tart, and sulph. morphia, every two or 
three hours. These, with moderate exercise in the open air, 
general quietude of body and mind, simple and nutritious diet, 
will afford the best means in our power for the safe conduct of the 
patient along her perilous path. 



BAVAGBS OF DIPHTHERIA. 

It is estimated that at least ten thousand persons — ^mostly 
the young — ^have fallen victims to diphtheria since its first ap*- 
pearance in the United States. 



102 Case qfa Child Born covered with Sulphur. 

ARTICLE II. 

•Ai Extraordinary Case. — A Child Bom covered with 
Sulphur. By A. A. Bucker, M.D., of Miami, Mo. 

[The follonving interesting case was commQnieated by the au- 
thor, in a letter to Prof. Frazer of this city, and by him kindly 
furnished for publication. — ^Eds.] 

On tlie morning of Nov. 13th, I860, 1 was called to see Mrs. 

H , whom I found in labor ; the second stage of which was 

about completed ; suffice it to say, the labor was a natural one, 
and went on well to its completion ; at which time a strong odor 
of sulphur came in contact with my olfactories. I could not 
imagine at first from whence it emanated, but, on looking at the 
child, which for a moment seemed lifeless, I saw its color much 
resembled that of sulphur ; but not thinking of sulphur from such 
a quarter, although the odor was strong, I thought for a moment 
of that appearance which syphilis sometimes gives to still-born 
infants. But here, from every circumstance, I dared not for a 
moment presume this monstrous disease to have any thing to do 
in the matter. But on placing my hand upon the cardiac region 
I found the heart pulsating, and I went immediately to work, to 
resuscitate my little acquaintance ; which soon being done, I 
turned about to investigate why this odor and color, which at this 
time I began to suspect came from the child and mother. I en- 
quired of the latter if she had in any manner been using sulphur 
about her person ; she stated she had only been using it inter- 
nally, and for several weeks, in doses near a teaspoonful. Upon 
a minute examination I found the infant thoroughly covered, as 
it were, with an unguent of sulphur. If you had taken sulph. 
oint. with sulphur largely predominating and well smeared the 
infant with it, you would have no better evidence as far as ap- 
pearance and odor would go. Unfortunately^ I did not preserve 
any of this matter, and am therefore dependent upon sight and 
smell — evidences, I know, which will not always do in medicine 
or its CO -branches. 

But if I ever saw or smelled sulphur, I did in this case. For 
fear that I might be in some error about this matter, I again, in 
some ten days, visited Mrs. H for the purpose of eliciting if 



Foreign Corre$pond$ne€. 108 

possible, more and stronger evidence for or against the sulphur 
position. Upon conversing with the lady, she informed me that 
upon the second day, and third day, she attempted to wash and 
clean the infant, as it had been imperfectly done by the nurse, 
and, to use her own expression, ^' why, Doctor, I found sulphur 
between its fingers and toes." After every possible examination I 
could make, save the omission referred to, I am compelled to 
say this infant was literally covered with sulph. ointment, pre- 
pared in a sort of nature's laboratory. Now, if this was sulphur, 
and I have not the least doubt, it opens up some very interesting 
questions concerning the foetal existence in utero. I have stated 
hurriedly and very unmethodically the above facts. If you can 
give me any light or information concerning the matter, it will be 
highly appreciated. 

Should you deem this case worthy of publication, you will 
please nse it. 



ARTICLE III. 



Foreign Correspondence. — Letter from Dr. F. CoOLBT, qf 
Lexington J Missouri. 

No. 7 Falcon St., London. 
Prof. McPhbbtbrs. 

My Dear Sir : — Since writing you I have witnessed a number 
of highly important surgical operations, some of which I shall 
now talk about. Before doing so however, I wish to say a few 
words about the great surgeon of London, Mr. Fergusson. He 
18 slightly over six feet in stature ; large and well proportioned, 
and has a pleasing expression of countenance, but is quite bald — 
he always enters the operating theatre with a smile on his face ; 
he is between fifty-five and sixty years of age, though looks rather 
young for one of that age ; he is not a fluent speaker, having a 
slight impediment in his speech, though he articulates so as to be 
distinctly understood. He operates with great ease to himself, 
and without the least trembling of the hand. He proceeds with 
his operations, apparently, with perfect confidence of his ability 
to perform them successfully, and does not manifest the slightest 



104 Foreign Correspondence. 

embarrassmenty or the least disposition to hiuny through with 
them. 

To sum the whole matter up in one short sentencoy he seems 
to possess all the necessary qualifications of a good operator. I 
have had the pleasure of witnessing the resection of the knee, and 
excision or resection of the elbow, by him. The patient on whom 
resection of the knee was had recoorse to, was of a stmmons dia- 
thesis, judging from her general appearance. She had chronio 
disease of the knee, which had disorganized the joint, rendering 
amputation or resection absolutely necessary ; the latter Mr. Fer* 
gusson choso. He is quite an advocate for resection. If I am 
not mistaken, resection was resorted to more frequently some years 
ago in our country than at the present ; and I presume the rea* 
som for partially abandoning the operation was the want of sue* 
cess. But as Mr. Fergusson has justly remarked in his lectures, 
the surgeon should give his patient every chance which surgery 
can afford to save a limb ; and if the limb can be saved by the 
operation of resection, though an anchylosed joint, and a short- 
ened limb, should be the result, these are far preferable to no 
limb at all. In the case referred to, he thought it much better to 
resect the joint, as the foot and leg were sound, rather than to 
amputate the limb ; believing that the chances for recovery are 
in favor of resection over that of amputation. He remarked, 
that he had often regretted, on former occasions, especially 
in bis youngeA days, having resorted to amputation, when he 
might have saved the limb, and perhaps the life of the patient, by 
a resort to resection. But now, after years of experience, and 
after having more maturely studied the subject, and being ena* 
bled to act more independently, he more frequently resorts to re- 
section than to amputation, and sees no cause to regret the course 
he has pursued. He further remarked that there is a close anal- 
ogy between the knee and the elbow ; yet surgeons will hoot at 
the idea of resection of the knee, because, say they, it interferes 
with the development of the limb ; I would ask, said he, if there 
is any development of the limb after amputation! Those sur- 
geons say resection of the elbow may be performed with some 
hopes of suecess, but not so with re- section of the knee. Re* 
section of the knee is a serious operation, and is sometimes fol- 
lowed by death ; and so is amputation a serious operation, and 



Foreign Correspondence. lOS 

frequently followed by death also. I will pat in contrast a ease 
of resection of the knee at the London Hospital, and the result, 
with Mr. Fergusson's teaching. The case I have reference to is 
a little girl some twelve years of age, admitted under Mr. Curl- 
ing's care. The left knee was inflamed, swollen, and painful — 
several sinuses communicated with the joint — two or three over 
the patella, and one on the outer side of the thigh. The patient 
was put under the influence of chloroform, and resection perform- 
ed. The cartilages were deetroyed and the bones extensively dis- 
eased. About one and a half inches of the femur, and about 
three quarters of an inch of the tibia, were removed. The patella 
was also removed. For several weeks the case seemed to be pro- 
grossing favorably ; the child got so she could go aboat ; but 
finally she relapsed, the sinuses reopened, and there was no bony 
union, the knee was intensely painful, and the girl's health de- 
clined. Amputation was decided upon, and accordingly per- 
formed ; and the result is the girl is now well, and has a sound 
stump. Mr. Fergusson went so far as to say, that a surgeon 
would be laughed at in these enlightened days were he to ampu- 
tate the leg or arm for disease of those joints. Unless the dis- 
ease was of the most serious character, and the condition of the 
parts would show at once the absolute necessity of an amputation. 
This is all well enough, provided you are able to diagnosft these 
serious cases. Surgeons are sometimes mistaken in their diag- 
nosis, as was the case with Mr. Curling, and I trow it may be 
the case with Mr. Fergusson himself. I shall keep my eye on his 
cases of resection, especially that of the girl whose knee was ex- 
cised. It would be a fortunate thing for suffering humanity if 
diseases of the joints could be remedied by resection, thereby 
saving the member ; for it is much better, as Mr. Fergusson 
justly remarked, to have a natural limb, though it be anchylosed 
and shortened, than to have no limb at all, or to have an artifi- 
cial one ; but, unfortunately for surgery, resection has not always 
succeeded iu bringing about these good results ; for, even after 
resection of the joint, ampuration of the limb in a number of in- 
stances has finally to be resorted* to in order to save the life of 
the unfortunate individual. If it were possible for resection to 
succeed in every instance it would be a mighty triumph for sur- 
gery ; but alas ! such is not the case. 



106 Foreign Corrtipondenee. 

The London medical gentlemen are making considerable ado 
over an instrument recently invented by Prof. Csermak of Berlin, 
called by that distinguished surgeon the ^^Laryngoscope," an in- 
stmment used for the purpose of diagnosing diseases of the 
larynx. It is said the value of this instrument in the diagnosis of 
affections of the larynx has been recognized all over the continent 
of Europe, and its employment has become somewhat general in 
a number of the public hospitals. The aid of the laryngoscope 
in diagnosing diseases of the throat is therefore of the greatest 
importance. The instrument consists of a reflector and mirrors. 
The reflector can be placed at any angle you may wish, thereby 
enabling you to examine any and every part of the larynx with 
perfect ease. There is one difficulty in the way in examining 
patients with the laryngoscope, and that is, the irritability or 
sensitiveness of the parts against which the instrument is brought, 
though I believe the only portion touched in the examination is 
the uvula. 



Paris, December 24th, 1860. 
Prof. McPhebters. 

My Dear Sir : The manner in which the hospitals are ar- 
ranged here seems to be good ; the wards and the beds are clean, 
and the patients appear comfortable, as much so at least as 
hospital patients can be. It requires an immense amount of 
labor to keep so large an establishment in a cleanly condition. 
The hospital I visited this morning contains some six hundred 
or more beds. *^The Hospital Lariboisi^re,'' where we met 
with M. Ghassaignac, who is rather a good humored man, and, by 
the way, a great talker. It would appear from the display to-day, 
that he is much wedded to the ^^Ecraseur" and the seton. He 
performed some half dozen surgical operations, and all with the 
<«Ecraseur," and with the trocar and canula. He operated for 
fistula in ano with the ^' Ecrasenr ;" also removed a tumor with 
the same instrument. For hydrocele, he operated with a large 
trocar and canula, followed by a seton : for abscess and sinus of 
the elbow implicating the olecranon, he operated with the trocar. 



Foreign Corre$pandencB. lOT 

To give exit to matter in a large abscess on the anterior aspect of 
the thigh, be used the trocar and seton. He has operated so often 
with the ^^Ecraseur'% that he has become quite familiar with the 
instrament. In mammary abscess, he operates with his large 
trocar and canula, followed by the seton. In almost all surgical 
cases where an American surgeon would employ the knife, M. 
Chassaignac either uses the *^ Ecraseur" or the large trocar and 
seton. From the ^'Hdpital Lariboisi^re" I went to the eye infir- 
mary, conducted by M. Desmarres, and where I had the pleasure 
of seeing over one hundred cases of diseases of the eye ; and also 
witnessed several operations. For granular conjunctivitis, he 
uses almost altogether the sulphate of copper applied in the solid 
form. Internally, he gives little or no medicine. This is a pri- 
vate hospital established by M. Desmarres, and as a matter of 
course he has the entire management of it. The time he devotes 
to his patients at the hospital is gratuitous. Wherever we find a 
hospital of this description, it is filled with patients, both in and 
auL Jobert is at the old Hdtel Dien, one of the largest estab- 
lishments in Paris. The wards are full, as is the case in all the 
hospitals I have visited. Jobert is much of a gentleman ; he is 
very courteous to Americans, much more so than M. Malgaigne. 
In the wards of the Hdtel Dieu, we saw quite a number of inter- 
esting cases, such as aneurism of the carotid, &c. 

The old veteran, M. Yelpeau, is still going the rounds in the 
wards of the '^Hdpital de la Charit^,'' and is yet a splendid opera- 
tor notwithstanding his age ; he does not look as old as ho really 
is. His walk is that of a man twenty- five or thirty years of age. 
He has a pleasing countenance, and seems ready at all times to 
exchange a pleasant word with you. There is one peculiarity 
about Yelpeau I must not forget to mention, which is this : he 
is now wearing the same lUile red cap he wore twelve years ago, 
and how much longer anterior to that time I am not able to say. 
This little red cap is worn only in the hospital during his visits, 
and I suppose he thinks he has a perfect right to wear it until it 
wears out, should it require twice twelve years to do this. Not- 
withstanding his little red cap, M. Yelpeau is one of the greatest, 
if not the greatest, surgeons in Paris. In this hospital we also 
saw M. Malgaigne, who is a very different sort of a man from M. 
Yelpeau. Yelpeau, as I have already said, is kind and affable to 



108 Foreign Corre$pondenee^ 

the Americans, whereaa Malgaigne, bo I am told, hates our eoun* 
trjmen. Why he dislikes as, I can not tell, unless it is from the 
fact that he is jealous of Velpeau, and because of M. Yelpeau's 
kindness towards the Americans. I am told he dislikes erery 
thing that is not of Paris. Malgaigne is, nevertheless, a man of 
high attainments in the profession, and ranks with the first sur- 
geons in Paris. 

From what I can learn, the French surgeons do not use as much 
medicine as the English do, nor as much as the Americans. If 
we would all use less than we do it would probably be better for 
our patients ; for, after all, nature is the great physician, and 
our aim should be not to force her, but rather let nature have her 
perfect work. The material they have to operate on here is some- 
what different from what we have in our country. The mass, or 
a great majority of the patients admitted into these hospitals are 
of the lower class, and consequently, badly fed, and frequently 
badly clothed ; and should a surgeon lose a case after an opera- 
tion, it does not amount to much with them, or to the commu- 
nity ; at least they look upon the matter in this light, and this 
leads them to experiment more than in any other country. I am 
sure Americans would not submit to what the French are com- 
pelled to. It is our business, however, to take advantage of all 
we can gather from Paris, and from Parisian practice. 

There is evidently a jealousy existing between the Parisian and 
Che London surgeons. Neither will practice what the other does, 
if they are aware of it. In one respect, however, they resemble 
each other, and that is, neither of them will go from homo to 
acquire medical or surgical knowledge. 

Respectfully yours, p, Coolby. 



ARTICLE IV. 

[For the St. Lonli Medical Jonmal ] 

LETTER FROM DR. S. POLLAK. 

Paris, Dec. 16, 1860. 

AN ITINEBANC7 TO, AND THROUGH, 60MB OF THB HOSPITALS 

OF PARIS. 

Correspondents from abroad have been in the habit of writing 
out, or reporting lectures, or some interesting operation, which 



Foreign Carre^andence* 109 

are asaally found in the medical journals. To report a lecture 
requires more than ordinary skilU Few of ns understand, or 
speak French well enough to take notes verball j, even if we could 
write suflSciently fast. We must trust greatly to memory. Then 
justice is hardly oyer done to the lecturer. One word added or de- 
ducted from what the lecturer realfy said, may change his mean- 
ing entirely. Whenever yon find a faithful report of a Parisian 
leeture, take it for granted it is a mere iranskUion from a 
journal. 

The Parisian hospitals, with the exception of one, the Lari" 
hoiri^t^ are certainly the poorest looking estsblishments imagin- 
able. But for the most perfect system of discipline and order, 
and the most exemplaiy organization, it would be impossible to 
attain good results. 

The hospitals of Paris, though founded at different epochs, by 
kings, princes, ecclesiastics, or rich men, and for a long time 
managed according to their own constitutions and by-laws, 
wholly independent of each other, have, since the revolution of 
1789 been centralized and brought under one administration. 
The present organization, however, dates from the 10th of Jan- 
uary, 1849. It is under the immediate authority of the Minister 
of the Interior, and the Prefect of the Seine. The Board consists 
of a President and a Board of Council — the members of which 
are taken from nearly all classes of society in Paris. One third 
of the members go out every two years. It is known under the 
name of ^^ L'Administration g^n^rale de I'assistance publique 
a Paris." Sixteen hospitals, general and special, nearly as many 
dispensaries, medical schools, institutions for the blind, the deaf- 
mute, and the insane, are all under its charge. It is the most 
extensive and most complete hospital organization extant. Most 
of these charity hospitals contain pay and graiuitous patients. 
A polyclinic is held in all of them, where out-door patients re- 
ceive medical advice and medicines without charge. The number 
of applicants at these consultations graiuiies is fabulous, but 
not more so than the trifling expense at which they are conduct- 
ed. A most important lesson is to be learned here on that score. 
The access to the hospitals is very restricted for visitors. Even 
physicians must present themselves, first, to the directors of each 



110 Foreign Corrtspondence^ 

hospital, and for two of them, the Loureine and the Matemiii^ 
it requires an especial permission from the Director -general. 

A written application, stating the object of the visit and conn- 
tersigned by the Minister resident, must be made. This I did, and 
our amiable Minister, the Hon. Mr. Faulkner, readily afSxed his 
name to it. The permission was at once granted. I also applied 
for books, pamphlets, and reports, relative to the *^ Administra- 
tion g6n^rale de I'assistance publiqne," which were at once given 
me — ^fifteen volumes of most invaluable matter, from which our 
Board of Health might derive many useful and important hints. 

So much as a preliminary — ^now for the visits. I begin with 
/a CharziS in the rue Jacobs it being nearest to my home. An 
old dingy looking house, with 494 b^ds, 247 males and 247 fe- 
males. The physicians en chef are : Piorry^ Bouiilaud^ Bri- 
queij JVbnalj PeUetan and Beau. Some of them are great lights. 
The surgeons, Velpeau and Malgaigne are celbbrities. The 
veteran surgeon Velpeau is on the decline, on account of great 
age. His clinic, though numerously attended, is not profitable. 
He is followed by a corps of twenty- four internes and externes — 
white- apron men — ^who necessarily occupy the first place around 
the bed. Neither students nor visitors can get near it. Of course, 
seeing is a rarity if not an impossibility. Velpeau speaks now 
so low, that even hearing becomes difficult. Follow him in the 
amphitheatre, the same difficulty exists there ; I saw him operate 
twice, and do not care to attend him again. The day of his great- 
ness is passed. His obstinacy in absolutely resisting every pro- 
gress in science, in which he was not immediately instrumental, 
renders him exceedingly unpopular. His resignation is anxiously 
looked for. 

M. Malgaigne's clinic is followed by none. He is absolutely 
forsaken at the sick-bed. He neyer operates^ he only lectures. 
As a lecturer on ^^op^rations et appareils,'' he has no equal ; he 
is certainly the most brilliant and popular in Paris. It is strange 
that he who speaks so well about operations, and who has invented 
so many instruments, and criticises and rejects so many more, 
should never venture to perform an operation. His lectures at 
the £cole de Medicine, from four to five o'clock, are immediately 
preceded by Monsieur Ouillot on Pathologie Medicale — an iniol* 
erable bore — ^who walks up and down on his rostrum, talking to 



Foreign Correspondence. Ill 

himself, not noticing his hearers, if there be any, who are talking, 
laughing, smoking, throwing filberts at each other and at him. 
He closes precisely at 4, nhder hisses, and yells, and cries of 
Piwocai ! Pavocai ! ! In the meantime the hall commences filling, 
until it is replete to overflowing. Malgaigne comes, and is re- 
ceived with shoots of applause. He at once starts off 'Mn a 
gallant style." He speaks extempore, is extremely eloquent, at 
onee satirical and witQr. He keeps the audience in a state of 
constant excitement and hilarity. His manners are theatrical* 
One feels as if being rather with a satirist than a teacher of seri- 
ous subjects. He entertains, he amuses ; but certainly does not 
teach. The hearers come in for recreation, but not for edifica- 
tion. I have yet to learn what is the good of his lectures. Wheth* 
er we know the whole armory of surgery of by-gone days or not, 
adds very little to our skill ; cutlers get rich by it, but surgeons 
are not wiser, and patients not better. The chair of Malgaigne 
might be readily abolished. 

At La Charil6, Piorry attends chiefly to the chest diseases, and 
Nonat to the women. Every Thursday, he holds a consultation 
gratuiie for out- door women. Not less than fifty present them- 
selves, who are all, without exception, examined with the specu* 
turn. Such abuse of an instrument, and such brutal ineflScient 
treatment, I never thought possible. His diagnosis is as false as 
his treatment is stupid. Woe to the young physician who would 
receive his first instruction there. Still they are in attendance 
by dosens. Whether attracted by an indelicate curiosity, or be- 
cause they really believe much can be learned, I can not say. 
Certain it is, such a mode of procedure would not be tolerated in 
our country, and should be repudiated here. The other chefs only 
attend their wards, each having several internes and externes at- 
tached to his service. 

The next hospital I saw was PHdpUalde la Facultcy where I 
only attended a few times with N^laton, the most brilliant sur- 
geon of Paris. He is as handsome as he is intelligent, and as 
agreeable as he is learned. This hospital, also, is absolutely un- 
worthy of Paris. Nothing but the interest afforded, and infor- 
mation acquired, by such a man as N^.Iaton, would induce me or 
others to visit it. His clinic is excessively crowded, not only by 
students but old practitioners. His internes have not the pre- 



lis Foreign Correspondence^ 

rogatWe of monopolising tbe bedside. Henoe by being posted 
about the interesting cases, and taking the stand in time, one 
reaps the full benefit of that man's observation. He speaks 
clearly, loudly, and to the point. Following him in tbe small, 
illy constructed amphitheatre, where every inch of ground is occu- 
pied by eager and attentive listeners, he elucidates in a most 
felicitous, extremely instructive^ manner, the cases in the ward, 
and those to be operated on. He is eminently practical and 
philosophical, and never fails to leave you without a perfectly 
clear understanding of the case. I never will forget his remarks 
on abscesses in the medullary substance of the bones — his illus* 
trations on the black-board ; still more on the old pathological 
specimens ; and then the operation, with the trephine on the hu- 
merus, for this, disease, which not only verified the extremely 
difficult diagnosis, but gave unspeakable relief to the patient. I 
could not do justice, by reporting from my memorandum his 
learned remarks. A word omitted would be an irreparable loss. 
I bought his work on this subject, which will be at your disposul. 
He alone is worth a visit of a month in Paris, not only for the 
surgeon but the pathologist. Such men as N61aton give 6clat to 
an age, and reputation to a medical school. I have seen opera- 
tions performed as well, but never saw them introduced in such a 
forcible, clear manner, carrying conviction of his views and ao* 
quiescence in his proceedings. The other wards of the Faculty 1 
have not seen yet ; one of them is of considerable interest. I 
mean the ^^clinique tP accouchement ^^^ under Paul Dubois. I 
will refer to it on some other occasion. 

The Hotel Dieu is the oldest hospital of Europe, having been 
built in 660 ; and for nearly ten centuries it was the only hospi- 
tal of Paris. It has 810 beds ; 430 for male, 880 for females, 
555 for medical, and 255 for surgical cases. It is a most incon- 
venient institution, being built on both banks of the Seine, with 
the two parts connected together, by a paseerelle, and a pont 
volant. The service there is very difficult. A total removal of 
the building has been long spoken of, and is much desired. I 
only attended a few times the clinic of M. Trousseau, one of the 
glories of the profession, and the pride of Paris ! He is a very 
handsome man, of dignified but courteous demeanor. His clinique 
is not in the least better attended than it deserves to be. Men 



Foreign Correspondence. 118 

already high in the profession follow him; for he is always 
instrnctiye, philosophical and agreeable. The crowd is too 
large to profit much at the bedside, although he speaks loudly. 
The lecture room is always replete to overflowing. His true 
greatness is at once manifest. His voice is beautiful ; his ges- 
tures apropos; his language choice; his emphasis just at the 
right point ; his ideas are clear, well digested, admirably express- 
ed and convincingly true. These truths are not only conveyed by 
sound reasoning, but by ocular demonstration on pathological 
objects. 

The medical clinics are not quite as conscientiously conducted 
in Paris as in Vienna and Berlin, where the crucible, the test- 
tube, the microscope, and other physical apparatus are con- 
stantly broQght into requisition ; but they are for all that good. 
As diagnosticians, they need fear no rival ; but their therapeu- 
tics would be wholly inapplicable in our country. £very moment 
spent in studying therapeutics here is time and labor lost. 
Infinite good might be derived from studying and imitating their 
admirable and rigid system of dietj which certainly, more than all 
their medicines, effects the cures. Their nurses are usually well 
schooled and experienced, not the first best ^^who wants a place." 
Their intelligence in watching, and the constant presence of nu- 
merous internes and exiernes for observing and rendering im- 
mediate aid, cause more good results than the learned clinical 
treatment during the grand visit. Besides Trousseau, there are 
in the Hdtel Dieu the following medicins en chef: Rostan, 
Piedagnel, Gu^rard, Grisolle, Legroux, Horteloup, Barth; and 
the surgeons are Laugier, Jobert de Lamballe, Robert. All have 
a corps of internes and exiernes attached to their service. 
The exiernes are those who have completed their medical 
studies, but have not yet graduated. In applying for an ap- 
pointment, they have to make a concours before a properly con- 
stituted board of examiners. The best of those examined are 
chosen. The appointment is for not less than one, nor more than 
two years. They do the minor surgery of the hospital, such 
as dressing wounds, cupping, &c. They receive six hundred 
francs a year, free lodging and board. After having been an 
exierne for not less than a year, he must make another con- 
cours if he aspires to become an inierne^ who does all the 
Vol. XIX — 8 



1 



114 Foreign Correspondence, 

medical duties of the hospital in the absence of the chef. The 
appointment does not exceed five years ; they must change hos- 
pitals every year and rank according to seniority. Their ap- 
pointments are the same as the externes. What an immense 
advantage for a young student to receive such an appointment I 
While on duty for five years, they prepare for the final rigorous 
examination to obtain the degree of M.D., &c. Of course, there 
must be some slight difference in the requirements here and in 
the United States. 

The Salpetrihre is only remarkable for its enormous size, oc- 
cupying not less than 90 arpens of ground, mostly covered with 
buildings. There are 4869 beds ; of which 3048 are for aged 
females, and 1821 for the insane females. There are no males 
in the Salpetri^re. With the attendants and officers there are 
6800 persons in the institution — quite a respectable sized town ; 
the food for aU these is prepared in one kitchen ^ which is really 
not much larger than many of our hotel kitchens. The laundry 
is also a most interesting department ; for they not only do the 
washing for the large population of the Salpetri^re ; but also for 
three more hospitals, namely, the Gharitd, Hdtel Dieu, and Beau- 
jon. An army of feminines stands around the immense basins 
of running water, doing the work not half as well, and not one- 
eighth as fast, as one of our washing-machines would do it. 
However, Parisians are very slow to adopt things from abroad. 

The physicians en chqfvLV^y for the medical department : Cazalis, 
Richard. For the insane: Fabret, Mitivi^, Lelut, Trelat, Bail- 
larger, (the first and last eminent psychiatrists, and proprietors 
of large asylums for paying insane.) The surgeon is M. FoUin, 
quite a prominent surgeon and occulist. He gives every Satur- 
day a free course of lectures on the ophthalmoscope, with demon- 
strations with a large sized instrument. They are well attended, 
and quite instructive. Material is of course abundant. The 
changes of the interior of the eye of aged people can nowhere 
be better studied. 

The Hopital du Alidiy with 836 beds, all for males, is only 
for venereal diseases. This was the theatre of the immortal 
Ricord for nearly a quarter of a century. He is there no more. 
Ho has resigned his office as one of the surgeons of the Midi. 
According to law, hospital physicians must withdraw at 65, and 



Foreign Correspondence. 115 

hospital sargeons at 60 years of age. It is thought the hand is 
Bot steady after that period of life. But it is strange, profes- 
sors are permitted to retain their position for life ; else Yelpeau 
would have had to withdraw long since. Ricord is near, but nut 
quite, sixty years of age. He withdrew sooner, it is said, on ac- 
count of the loss of his prestige of being the infallible oracle in 
venereal diseases. Since he was forced to acknowledge his defeat 
by the German syphilographs, his temper has become soured, and 
he goes to medical reunions no more. His admirers will give 
him a banquet at the Louvre on the 20th instant. There were 
always three chefs at the Midi — one medical, Puche ; and two 
surgical, Ricord and GuUerier. The latter has taken Ricord's 
place, and Gusco is his successor, a brilliant young surgeon, who 
is rapidly stepping into the popularity and practice of Ricord. 
The latter has published a '^Farewell" work on Chancre ; the 
first edition has been exhausted as fast as issued. However, I 
got a copy. A few months' sojourn at the Midi will familiarize a 
person perfectly with syphilis in males, and also with the differ- 
ent, almost contradictory, views and treatment of the respective 
chefs. I will have occasion to explain and substantiate the last 
assertion. Whether they are here more successful in treatment 
than we are in the United States, I can not say. They certainly 
ought to be ; for they are not sparing in bold and most extraor- 
dinary means, which in private or even hospital practice in the 
United States would not be feasible. 

The HopUal de Lourcine^ with 276 beds, is the hospital for 
venereal females. Not even physicians are admitted, except with 
an especial permission from the direcieur gineral. It is under the 
charge of the Sisters of Compassion, a religious order. The 
wretched inmates leave the institution, not unfrequently, not only 
cured but reformed. The medicin en chef is Lailler ; surgeons, 
Ad. Guerin and Ad. Richards, the last one a rising star, already 
before the world as the author of many works on the natural 
sciences. He has to perpetuate the fame of his distinguished 
father, the botanist, and pathological anatomist ; and he bids fair 
to succeed. He is most courteous and communicative, (a virtue 
in which the Parisian chefs do no abound.) I will hereafter 
mention some of his new views and treatment of syphilis. In 
the Lourcine, the surgeon does not go round to visit, but he takes 



116 Foreign Correspondence. 

his seat in a small well- lighted room. The damsels come in, as 
they are called, are pUced on a well arranged coach before the 
light, and are at once speculated! a new word, bnt fully conTcys 
the meaning. A crop of venereal vegetations — condylomata — as 
large as a cabbage head, were clipped off with scissors, touched 
with the "Vienna caustic, and sent away, not rejoicing but scream- 
ing ; and he thinks cured, both of the disease and the vice. No 
other remedies are used. Vaginitis and the accompanying 
blennorrhoea is treated by tamponing with balls of raw cotton 
steeped in a solution of equal parts of tannin and glycerin. I 
was assured that of all remedies tried there for that stubborn 
malady, this has proven the most effectual. I can bear testimony 
to the eflSciency of this remedy ; I have used it long ago, only 
taking one part tannin to eight of glycerin, and always with bet- 
ter results than with any other remedy. As a general rule, there 
are very few medicines given in syphilis either at the Midi or 
Lourcine. Diet and bathing seem to be the main stay. Before 
I leave this city, I will take a private course in these two insticu- 
tions, and will be able to bring home some items which books do 
not tell. 

The Maison d^ •Accouchement or MaternitSj of 530 beds, is, 
like the preceding one, not accessible except by an especial per- 
mit from the directeur g6n6ral. The tnedicin en chef is Delpech, 
and the surgeons, Danyau and Beraud. The sage femme en 
chef is Mad. Alliot. 

This is not only a hospital for paturient women, but also a 
school for midwives, there being over 150 in attendance, who re- 
ceive a most thorough French education; a perfect anatomical 
and physiological knowledge of the pelvis and the female organs 
of generation ; of the process of gestation and parturition, &c. ; 
of pathology, they learn enough to know when such a condition 
occurs, so as to demand medical aid. They are requjred to com- 
plete a two years' constant sojourn, and to do all the menial 
duties needful about a parturient woman ; have to become gardes 
maladeSy and each, in turn, superintends the whole process of 
accouchement. Two thousand five hundred births are averaged 
every year. Their opportunities for learning are therefore ex- 
cellent. Lectures are daily given by Beraud and Mad. Alliot, 
who is not only a superior skillful accoucheuse^ but an uncom- 



Foreign Correspondence. * 117 

monlj fluent, clear teacher, a rigid disciplinarian, and a good 
excellent woman. I met an American lady from Pennsylvania, 
Mrs. Cleveland, there, who evidently has seen better days, bat 
now studies midwifery, with a view of practicing in Philadelphia. 
Mad. Alliot spoke of her in terms of the highest praise. Phila- 
delphia ladies may therefore feel at ease. 

I witnessed an accouchemeni ford by forceps, rapidly and 
successfnlly terminated by Danyau. On removing the placenta 
and examining the membranes, a perfectly round hole^ as if 
made by a bullet, was found on the part nearest the fundus uteris 
On enquiry of the mother, she stated that she had been wet 
during nearly the whole period of gestation. There must have 
been a stillicidium amnii going on, and had the hole been on the 
lower part of the membranes, the amniotic fluid would have escaped 
entirely and abortion have resulted. Danyau, a man of 70, and 
40 years in service, mentioned this to be the third case on record. 

The MaternUe is illy constructed, the rooms low, badly venti- 
lated and lighted, and yet they hardly ever have an epidemic 
there. As a tnaterntiS it is smaller that that in Berlin, and of 
course not one half the size of that in Vienna. It is a pity that 
physicians are excluded ; but on the other hand, it is praiseworthy 
for respecting the delicacy and privacy so needful to parturient 
women. 

The Hopital de Lariboin^rey of 612 beds, equally divided for 
males and females, but 408 for medical and 204 for surgical 
cases. This is the newest and the only handsome hospital in 
Paris. It is built in perfect imitation of the Hopital St. Jean 
in Brussels. It consists of six pavilions, separated by small 
gardens, and all six connected by an arcade. Each pavilion is 
three stories high, each story being one large hall. Of course, 
such an arrangement will secure ample light and air, and looks 
very cheerful and pleasant. The medicins en chef we : Pidoux, 
Tardien, Herard, Moissenet, Oulmont, and Duplay : the surgeons 
are Voillemier and Ghassaignac. Monday is the operating day 
with the latter, and I regularly attend him ; for he is racy, origi- 
nal, bold, and uncommonly instructive. Ghassaignac has an 
ecrasamania. In most cases where other surgeons use a sharp 
cutting instrument, he uses the ^craseur. Tumors are not touch- 
ed vrith any thing else. I saw him operate on three persons, each 



118 Foreign Correspondence. 

with a doable fistala in ano, through which a tube de drainage was 
passed ; he attached a thread to the tube, drew it through the 
fistula, and with the same thread the end of the chains of the 
^craseurs (2) was drawn through, both worked at once, and both 
fistulas divided at once, without the loss of a drop of blood ; no 
dressing was made nor required ; the patients went on their way 
rejoicing. A eareinoma of the rectum as large as a child's head 
was removed in the same way, leaving a most awful gaping 
wound ; no blood escaped, and the wound is healing kindly. I 
might multiply cases, but they are not now new to any one. But 
he has another new hobby, which he rides to death, upon which 
he recently published two large volumes — ^his tube de drainagtj 
which he uses in cdl cases where a suppurative inflammation is 
established or desired to be maintained. It consists of small 
india-rubber tubes, perforated with numerous round holes, which 
are drawn through an inflamed organ by means of a trocar, as 
we would a seton, and there left. Nothing can surpass the beau- 
tiful immediate results, after such simple and most rational treat- 
ment The tubes do not cause irritation. By their use mam- 
mary abscesses have lost all their gravity and terror. The 
remedy is cheap, easily applicable, and should be in every prac- 
titioner's pocket, as it certainly will be in less than a year. ThzSj 
and the treatment of fractures with gypsum exclusively and 
never with splints^ are the two greatest discoveries I have m^ 
with in Europe, and they are perfectly worthy to be perpetuated; 
The Hdpital Saint Louis has 858 beds ; 221 for males, 329 
for females ; 657 for medical, 196 for surgical cases. This is ex- 
clusively for cutaneous diseases. The world has no other like it. 
In no form does disease appear more horribly disgusting than jn 
the uncountable and unaccountable forms of skin diseases. The 
medicins en chef 9,re Bazin, Gasenave, Hardy, Devergie, Oibert, 
Hillairet. The three first are celebrities of no mean order. Their 
works are standard; their classification is about the same as 
Willan and Bateman, and their treatment, even if better, is not 
more successful than ours, except in their management of ia 
gale or the itch. One half of the patients coming to the consul- 
tations gratuites are afi'ected with the gale. The furrow through 
which the aoarus might have made his entry is sought after, and 
if it is found it establishes the character of the malady beyond 



Foreign Corresponrience. 119 

qaestion. The patient is told to come back on Saturday^ the 
great rubbing Aaj^ and he will be cured in two honrs. On that 
day, all the cases that have accnmulated during the week present 
themselves, and the following process is gone through with : 1. 
Rubbing the whole body for halF an hour with strong black soap ; 
2. Bathing in warm water another half hour ; 3. Then rubbed 
with an ointment consisting of sublimed sulphur \j sub-carb. 
potass, fj, lard 1 part, for another half hour. I am told 
that not once in a thousand cases does a relapse occur. It is a 
curious burlesque sight to see one hundred naked men or women, 
rubbing themselves or each other ; to see them go in covered with 
itch, and come out cured. Any parasitocidal remedy might do 
the same — ^hence turpentine, corrosive sublimate, arsenic, red 
precipitate, etc., would answer, without so much ado, and without 
danger to the patients. I do not admire their treatment half as 
well as Hebra's in Vienna. However, I will familiarize myself 
with it. I go there every morning from 8 to 11, and will con- 
tinue to do so until January 1st. I dare say, in advance, that 
their practice would not be feasible with us; two -thirds of the 
patients would be better out than in. 

I will close by briefly referring to the eye clinic of Desmarres, 
which I am attending daily from 12 to 8. This is not a hospital, 
but a private dispensary of M. Desmarres, the first oculist of 
Paris. From 250 to 800 cases present themselves daily. The 
order observed is the following : 1. Those to be cauterized, and 
with lacrymal fistulsd ; 2. The children ; 3. New cases ; 4. Those 
to be operated upon ; 5. Those who have been operated upon ; 6. 
Ophthalmoscopic inspection. Nos. 1, 2 & 5 are gone through 
with at the rate of four in a minute ; with the others more time 
has to be taken. The clinic is chiefly conducted by Desmarres 
JiUy a most promising, brilliant, and already prominent young 
man, in presence of Desmarres ptre^ who watches carefully and 
lovingly his hopeful son. It is incredible with what promptness 
and exactness he diagnosticates, and with what dexterity and 
safety he performs all minor operations. I asked him once, 
*' comment pouvez vousfaire fe diagnostique, fans regarder le 
mtilade?^^ *'•/!? le flaire^^^ I smell it, was his answer. It almost 
appears so. As soon as one approaches, he calls out to the 
registering clerk the diagnosis and treatment, or orders him in 



120 Report on Diphtheria* 

the operating room, or in the dark room for the ophthalmoscope. 
This department is superintended by Dr. Golzenowsky, a Pole, 
long with Desmarres. The old gentleman performs all opera- 
tions in a most graceful and skillful manner. Five to six oper- 
ations daily, especially Mondays, Wednesdays and Fridays ; Thurs- 
day is exclusively devoted to the ophthalmoscope. Grsef's clinic 
is more brilliant, but not as large as that of Deamarres. He is 
eminently practical and philosophical, like him. He is a double 
millionaire, and like him, has a practice of 250,000 francs a 
year. This clinic is founded and maintained by himself. Imag- 
ine the amount of good that man does in this world. Physicians 
from different parts of the world attend here, and pay twelve 
francs a month, which goes to the concierge, Desmarres ptre 
accepts nothing. Desmarres Jils gives private courses, at 150 
francs a month, and so does Golzenowsky, at the same rate, for 
the ophthalmoscope. I am with both, and will continue while I 
am in Paris. 



ARTICLE V. 
DIPHTHERIA. 

•^ Report to the St. Louis Medical Society. By Tnos. Kbn- 
NARD, M.D., Physician to the St. Louis Dispensary. 

It has been recorded more than once in the history of our pro- 
fession, that a disease peculiar in character and fatal in its effects 
has prevailed epidemically in various parts of the world, spread- 
ing consternation and baffling the ablest efforts of medical men, 
and after sweeping off thousands has itself died out and been for- 
gotten for ages, then reappeared and been considered a new dis- 
ease. Such has been the case with diphtheria, whose history has 
been traced by some to the days of Homer. The sage of Cos, 
who lived four hundred years before the birth of Christ, is said to 
have alluded to it, and there can be no doubt that Aretseus, a 
physician of Oappadocia, and a most inquisitive man, left us a 
good description of this — to him, no new disease — having been 
known for years previous in Egypt and Syria as Syriac ulcer. 
His description of its etiology, symptoms, and fatality, applies as 



Report on Diphtheria, 121 

well to the trouble we have had to contend ivith as it did more 
than twelve hundred years ago. Three hundred and eighty years 
after the birth of our Saviour, Macrobius met with it, after which 
we lose sight of it for nearly a thousand years, when Holland is 
scourged by it, at intervals, for nearly two centuries, and then for 
the first time it reaches Paris in 1676, decimating its inhabitants; 
and a half century later, we hear of it in Spain, and then in 
Naples, where it prevailed epidemically for twenty years. From 
1650 to the time of its reappearance in France in 1740, we have 
but meagre accounts of it ; but after this it crossed over to Eng- 
land, and about the same time was described in our own country 
by Dr. Dickinson, who gave an account of the epidemic in New 
Jersey during 1784 and '86. In 1761, we hear of it in Sweden ; 
and again in 1771, Dr. Samuel Beard mentions its prevalence in 
New York. From that time until Bretonneau of Tours described 
it in 1826, we have but little trace of it. From the appearance 
of his masterly memoir until the present day, we have had to 
contend with it throughout Europe and America. That the dis- 
ease is the same in nature, varying in degree but not in kind, 
presenting shades of difference in every age, and in almost every 
epidemic, we can not doubt. Whether we study it as the Syriac 
ulcer of AretsDus and Alaymus, the gorotillo of Spanish authors, 
the ^^male de carina*^ (trachea disease) of Italy, the angine of 
France, or the angina suffocativa of America, it is one and the 
same pseudo-membranous sore throat or diphtheria of modern 
authors. In each and every epidemic we find the characteristic 
exudation, forming in the fauces and extending to the nares and 
sometimes to the trachea ; the occasional accompanying eruption 
and marked prostration ; the strangely insidious mode of attack 
and defiant course, and the same distressing sequelae. We find 
it frequently mistaken for scarlatina, and always resembling 
croup ; the initiatory fever, the great weakness without apparently 
sufficient illness, the intense redness of the fauces, followed by 
the characteristic gray patch or ulcer, and the frequently suffoca- 
tive dyspnoea, have always been the same in nature, though differ- 
ing somewhat in every country and epidemic ; some cases proving 
perfectly amenable to treatment, and others defying the best 
efforts of man. 
We almost all agree now in considering it a specific disease, 



122 Report on Diphtheria. 

the formation of the false membrane characterising it as sncb ; 
and we also think it a blood disease affecting the whole system, 
differing from cronp, differing from scarlatina, resembling more 
or less, but not the same as gangrene of the fances, or any other 
affection of the throat. No scientific or accurate diagnostician 
confounds it with other diseases, or fails to perceive its effects up- 
on the whole system and its peculiar exudation. 

J^ature. — ^Authors still differ as to its being contagious, infec- 
tious, or simply malarial ; and from the fact of its appearing spo- 
radically, sometimes as an epidemic attacking all classes and ages, 
the rich and the poor ; the inhabitant of eleVated healthy country 
as well as the denizen of the low, swampy, bilious districts ; the 
dwellers in the mountains, and those who live by the sea-shore; 
those who luxuriate in the mansions of wealth and the starving 
poor of our crowded and ill-ventilated tenement houses — we can 
hardly confine it under either head. Trousseau says : '^In the vil- 
lages of the Loire, remarkable for their salubrity and their ex- 
cellent position, I have seen diphtheria prevail to a terrible ex- 
tent ; whilst the villages of Sologne, situated in the midst of 
marshes, remained exempt ; and, again, hamlets bordering upon 
ponds, depopulated by the epidemic, while others enjoyed a com- 
plete immunity." 

Another author (Mr. Ernest Hart of London): *^ It was ob- 
served of diphtheria in France, and it is equally characteristic of its 
course in England, that it did not obey any geographical or meteo- 
rological laws. It descended upon Tours in the rear of the 
legion of LaVend^e ; broke out in crowded and ill-ventilated bar- 
racks, and it spread throughout the town ; it visited alternately 
the open hamlets of the rural departments and the crowded courts 
of the great cities ; it raged in Orleans and in Paris, through the 
Sologne and in the Loiret; it reached the sea- side and fell with 
violence upon the infant population of the city of Boulogne. It 
appeared to be equally independent of atmospheric condicions. 
Was a theory formed that it depended upon solar influence, and 
that the heat of the summer months lent fresh force to its de- 
structive attacks ? soon it raged with greater violence in the winter 
months and during the cold season. Was a connection traced 
between the localities of its invasions and the marshy, ill- drained 
character of the land ? — the next season it was found to ravage 



Report on Diphtheria. 128 

dry and elevated stations with equal rage. It has been no less 
careless of the limitations of heat, cold, dryness and moisture, 
since it has established a camp in this country. * * * 
It has swept across the marshy lowlands of Essex and the bleak 
moors of Yorkshire. It has traversed the flowery lanes of Devon 
and the wild flats of Cromwell that are swept by the sea-breeze. 
It has seated itself upon the banks of the Thames, scaled the 
romantic heights of North Wales, and has descended into the 
Cornish mines. Commencing in the spring months, it has con- 
tinued through the summer ; and if extremes of temperature have 
appeared to lend it fresh vigor and the heat of the dog-days or 
the severe frosts and sleet of winter have fostered its strength, 
yet moderate temperature has not greatly abated its influence, 
and it has struck a blow here and there through all the seasons." 

As inextricable as our researches yet leave it, there must be 
some peculiar condition of the atmosphere, some unknown sus- 
ceptibility of the system favoring its propagation. No position 
in life can exempt us from it; and without proper hygienic rules, 
the wealthy and well provided for are but little less apt to suffer 
from it than the poor. Some have attributed it to albuminous 
urine, whilst others thought of parasitic origin, but neither idea 
seems to have gained much confirmation. There have been and 
still are many advocates of its contagiousness, from seeing many 
persons in the same vicinity, many children of the same family 
attacked by it, one after another ; and instances seem to prove its 
capability of being produced by inoculation, as when a physician 
or attendant has gotten it from accidental contact of the exuda- 
tion with his throat or nose. I am inclined to think it both infec- 
tious and contagious, and very much influenced by the atmos- 
phere ; not, however, by changes of heat and cold, or moisture 
and dryness, but some unknown peculiarity of its constitution. 

Pathology. — ^The one only characteristic lesion is the fibrinous 
exudation or false membrane which forms on the pharynr, tonsils, 
larynx, and often extends to the adjacent mucous membrane 
lining the nasal cavities, or the trachea. It is likely to attack 
any mucous membrane exposed to atmospheric influence or on 
any abraded surface. It has frequently attacked the vagina of 
females, and occasionally the conjunctiva — ^but seems to prefer 
the fauces, nares, and mucous membrane lining the mouth. 



124 Report on Diphtheria. 

This white, greyish or yellow exudation, as the case may be, gen- 
erally first manifests itself on the tonsils, as specks or circnm- 
scribed patches, which, unless checked at once, spread rapidly, 
covering in a few days the whole of the fauces, extending down 
the pharynx and larynx, and through the nares, and sometimes 
involving the SBsophagus and trachea and even the bronchial tubes. 
The membrane increases in thickness as it spreads, grows darker 
and more dingy, and after a variable time begins to be detach- 
ed first around the edges. Its consistency, thickness, and adhe- 
siveness, vary in different epidemics and cases. In the early 
accounts of the disease the subjacent inflammation seems to have 
been much more severe, producing, as it often did, destructive 
ulcers of the tonsils and violent adenitis of the cervical glands. 
Now we rarely have much destruction of tissue — nothing but a 
bright shining membrane is seen on removal of the exudation. 
Most pathologists agree that there is nothing specific in the na- 
ture of the false membrane, that it is not any form of parasitic 
growth as has been alleged, but is very similar to the false mem- 
brane of croup, consisting mainly of coagulated fibrin covered 
with epithelial cells. The lungs are usually normal in appearance 
except when the exudation has formed in the trachea and perme- 
ated the bronchial tubes, or the complication with pneumonia has 
produced congestion or hepatization. The kidneys have been 
considered by some to be more involved than any other organs, 
always manifesting signs of inflammation, and that albuminaria 
is almost a constant accompaniment of severe cases, particularly 
in children. The excreting function of the kidneys seems to be 
stopped ; and as a consequence a retention of morbid matter in 
the blood occurs. Others lay but little stress upon the renal 
complication, and state that the existence of albumen in the 
urine does not prevent the increased elimination of urea from the 
blood or produce blood poisoning. In the cases under my charge 
I have not examined the urine, but the secretion seemed generally 
free ; the other organs, except the eyes and ears, seem but little 
affected ; temporary blindness and deafness are quite common, and 
permanent deafness as well as complete loss of sight occasionally 
follow ; the skin is left dry and harsh, and the whole surface pre- 
sents an anemic appearance, and returns very slowly to its natu- 
ral healthy glow. 



Report on Diphtheria. 125 

iS^ymf^/oYTM.— Diphtheria generally rang a regular course, and 
is marked by the oharacteristio exudation as definitely as variola, 
scarlatina, or rubeola, is by the ezanthematous eruption peculiar 
to each. Sometimes the poison is so virulent that it overwhelms 
the system before even the false membrane begins to form. 
Oenerally, however, it commences as a common catarrh, with but 
little fever or general disturbance, and but slight congestion of 
the mucous membrane lining the fauces (which, however, rapidly 
increases), followed by the formation of the exudation, and 
marked prostration. Very bad cases are sometimes ushered in 
suddenly by violent vomiting and purging of a thin and very of- 
fensive fluid, followed by great stupor and prostration, with fre- 
quent pulse, dry skin, red tongue, great thirst and irritability of 
tiie stomach. The fauces are bright shiny-red, covered frequently 
with a thin film of mucus. In twelve or fifteen hours the stupor 
disappears, and violent delirium with high fever, hurried respira- 
tion, hacking cough, and coated tongue, ensue, followed quickly by 
exudation on the hitherto reddened mucous membrane. The strength 
fails rapidly, the skin grows moist and clammy, the sensation of 
choking begins to be felt, and convulsions commence, soon to end 
the awful scene. 

Again, it manifests itself with uneasiness about the throat — 
slight adenitis — gradually increasing from day to day, with little 
or no fever, and only a general feeling of malaise and loss of 
strength, approaching so gradually, that if we did not notice the 
characteristic exudation, we should mistake it for a slight attack 
of tonsilitis. Sometimes croupy symptoms prevail ; there is the 
same crowing cough; the distressing constriction across the 
larynx ; the rapid formation and extension of false membrane, and 
the consequent distressing apnoea and sudden death from suffoca- 
tion. In every case the most characteristic symptoms are mark- 
ed prostration, without apparently sufficient cause ; soreness about 
the throat, with violent earache and coldness of the surface. 

Diagnosis. — ^There ought to be but little difficulty in recog- 
nizing a disease so marked in its attack and so peculiar in its 
effects ; but it has been confounded with scarlatina, with croup, 
with malignant angina, and no doubt frequently with tonsilitis 
and common sore throat. To the quack and all who play upon 
the credulity of their patients it is very convenient and advan- 



126 Report on Diphtheria. 

tageoas to call all cases of throat affection, however trifling, diph- 
theria, and gain credit for caring an intractable disease, when 
they are really doing nothing, or worse than that, counteracting 
nature's efforts ; but it is the province of the true physician to 
diagnose, as well as treat correctly, every case presented to him. 
This trouble resembles true croup in the formation of a similar 
false membrane in the larynx and trachea ; in its frequently in- 
sidious mode of attack, and somewhat in the local and constitu- 
tional symptoms, especially the croapy cough and constriction 
about the throat ; but the marked prostration, feeble pulse, cold 
clammy surface and quite frequent recovery sufficiently char- 
acterize it. It can only be confounded with this disease when the 
exudation extends to the larynx and trachea, which is the excep- 
tion in diphtheria but the rule in croup. Croup generally destroys 
life in a few hours, and rarely lasts a week — two days generally 
closing the scene if relief is not afforded. Group is almost en- 
tirely confined to children under five years, and most frequently 
attacks those under two, whilst diphtheria is not so closely re- 
stricted to children, particularly to those of very tender age. 
Blood-letting, emetics, and calomel, are the great remedies in 
croup, whilst they are seldom warranted in diphtheria. It re- 
sembles scarlatina in sometimes being accompanied by an erup- 
tion, but absence of eruption is a rare exception in scarlatina. 
In the latter disease we have hot skin, high fever, and often vio- 
lent headache — the opposite to what we usually find in the former. 
In scarlatina, the exudation which we sometimes see, is not false 
membrane, and separates easily from the subjacent membrane. 
An attack from scarlatina does not protect from diphtheria, nor 
vice versa. The exudation on being removed in scarlatina dis- 
closes an ulcerated surface beneath, as in malignant sore throat ; 
but in diphtheria no abrasion or ulceration is seen, nothing but 
the bright shining membrane. It does not follow the same regu- 
lar course, in its approach or decline, as we observe in scarlet 
fever. It differs from all other kinds of ulcerated sore throat in 
causing no destruction of tissues and in secreting no pus. 

Treatment. — When the pathology and nature of any disease 
is neither rightly appreciated nor fairly understood, the treat- 
ment must be entirely empirical and of necessity different with 
every physician ; hence the great disagreement and dissatisfaction 



Report on DipJUheria. 127 

in many of the modes recommended for the cure of diphtheria. 
Like all troubles treated in times gone by, it was combatted by 
bleeding, blisters, and calomel ; and is even now subjected to a 
similar course by some. The bleeding and blistering has nearly 
died out, but some good physicians still recommend calomel in 
very small doses as the best of all remedies. 

Believing the disease, as most enlightened practitioners do, to 
be a constitutional one, and the exudation in the throat only a 
local manifestation of the general blood poisoning, and remem- 
bering that death rarely occurs from the formation of false mem- 
brane alone as in croup, I think our chief attention should be 
given to the deranged state of the whole system, and we ought to 
support the strength from the beginning, not forgetting however 
to watch closely the throat affection, and use such local applica- 
tions as sound therapeutics and general experience has proven 
most beneficial and effective in removing and preventing the de- 
position of false membrane upon the fauces, larynx or nares. 
The membrane is composed of coagulated fibrin, and certain rem- 
edies have the property of dissolving fibrin or holding it in 
solution, and thus preventing its abnormal deposit. All the com- 
pounds of chlorine seem to exert this power of dissolving fibrin 
and diminishing its amount in the blood ; hence, we would em- 
ploy chlorate of potash internally, chloriated solutions of soda 
and chloride of sodium locally ; all of which have been tried and 
found very beneficial, combined with proper tonic treatment: — 
Q. — ^Potasss chloras, 3 ii. ; Acid nitric, dilut., 3 iij. ; Elixir of 
calisaya; Aqua menth., pip. cm % iij. ; half tablespoonful every 
two hours, combined with muriated tincture of iron and quinine, 
in repeated doses, is good treatment for an adult. Locally we 
may use either a strong solution of common salt, or the following 
as a gargle : ^ — Liquor sod» chlorinatse, 1 ii. ; tinctura myrrhsB, 
3 iv. ; aqua ^ vi. To be used every half hour. Or, solutionis chlo- 
rinii and syrupus zingiberi, cui i ss. ; aqua, 3 vi. — M. ft. gar- 
garisma, ssepe utendum, combined with the following internally : 
Solutionis chlorinii, gtt. iv. ; syrupus zingiberi, 3 i. ; elixir of 
calisaya, 1 ss. To be taken every third hour. Nitrate of silver 
has been extensively used, and highly recommended as a local ap- 
plication by most physicians, but I do not think it combines so 
many good properties as either muriated tincture of iron, muri- 



128 Report on Diphtheria. 

atic acid, chlorinated solution of soda, solution of chloride of 
sodium, or turpentine. The solution of common salt is said to 
act favorably by causing free osmotic flow, and thus keeping the 
mucous surfaces so moist as to prevent and tend to remove the 
exudated fibrin. I have used it in a limited degree both as a gar- 
gle and external application, and with apparent benefit. Turpen- 
tine acts as a stimulant and astringent. In large quantities it is 
known to possess the property of coagulating albumen. Although 
many deny that volatile oils are astringent, the action of turpen- 
tine in checking hemorrhages in different parts of the body cer- 
tainly simulates that of an astringent, whether it does it by stim- 
ulating the nerves, controlling the minute capillaries, and thereby 
causing this contraction, or by a direct physical or chemical ef- 
fect upon the tissues, we cannot well determine. We know that 
it is rapidly absorbed into the blood, and exerts a general stimu- 
lant effect upon the whole system — at the same time that it is a 
local muco- stimulant, stimulating mucous membranes in a man- 
ner similar to cordials, carminatives and aromatics. It has long 
been used as an external counter-irritant, and nothing acts more 
favorably as such in diphtheria. I have not seen any notice of 
its use as a local application to the inflamed mucous surfaces in 
this disease ; but my friend. Dr. S. Gratz Moses of this city, one 
of our most reliable practitioners, informs me that he has made 
extensive use of this remedy and with most surprising success. 
He now employs it in almost every case as a local application, 
and administers chlorate of potash and muriated tincture of iron 
in full and frequant doses. Muriate of ammonia has also been 
recommended as a good internal remedy. Quinine is one of our 
most reliable remedies, and must be given in small and repeated 
doses, to act as a tonic or restorative haematic, supplying some 
deficiency in the blood. 

Our treatment must be expectant, but not timid or careless ; 
for in most bad cases the tendency is to death by asthenia, un- 
less the very rapid formation of false membranes should cause 
it by apnoea. We must sustain the vital powers from the begin- 
ning by free use of alcoholic stimulants, quinine, iron, and nutri- 
tious food ; regulate the secretions and excretions by purgatives 
and eliminatives ; check or change the local inflammation of the 
fauces ; always pay most attention to the constitutional treat- 



JRepofi on Diphtheria. 129 

ment, and never use nndae harshness and force in making local 
applications. No remedy combines more desirable therapeutic 
properties for the treatment of this disease than muriated tincture of 
iron, being a powerful' astringent, fair diuretic, admirable haema- 
tic and reliable tonic. This combined with chlorate of potash, 
quinine, and brandy, internally, and either turpentine, hydro* 
chloric acid, or some chlorinated solution, locally, has proven more 
efficacious than any other method. The acrid discharges from the 
nares may be corrected by repeated weak injections of sulphate 
of zinc, or chlorinated solution of soda, one part to twenty of 
water. 

Sequelag. — ^Many morbid conditions follow this disease. Gen- 
erally the system is very anssmic, the skin harsh, dry, and colder 
than natural. The sight and hearing are impaired, and some* 
times completely destroyed. Paralysis of both motion and sen- 
sation, or either separately, often supervenes. The palsy may 
be local, affecting simply the velum, palate, and pharynx, or the 
vocal apparatus, causing a difficulty in swallowing or speaking ; 
it may attack the eye, or either extremity, or both, producing 
hemiplegia and paraplegia ; and in some cases general paralysis 
comes on. There seems to be but little relation between the se- 
verity of the diphtheria and the consequent paralysis ; for mild 
attacks have been followed by fatal paralysis, and vice versa. 
It is not generally fatal, though slow and obstinate ; nor does 
there seem to be any necessary connection with albuminaria, as 
contended for by some. It must be due to the general blood 
poisoning. In the treatment of any of the sequelae of this dis- 
ease, we must remember that the system is struggling against the 
influence of a depressing poison, and whatever special treatment 
may be indicated for each particular case, we must always sus- 
tain nature, support the system by the most nutritious and diges- 
tible food, as milk, eggs, and fresh meats ; by alcoholic stimu- 
lants ; by the judicious use of quinine and iron ; by free access 
of fresh air, frictions to the paralyzed part, if an extremity ; by 
electricity, locally applied, and by strychnia, or warm sulphur 
baths, as the case may require. 

Vol. XIX — ^9 



130 On Phthisis PulmonaHs. 

ARTICLE VI. 

PHTHISIS PULMONALIS. 

•tf Paper read be/ore the Pike and Lincoln Counties Medical 
Society. By C. R. S. Curtis, M.D., Clarksville, Mo, 

Perhaps no subject from the earliest history of medicine to the 
present day has received as much patient and diligent investiga- 
tion from medical philosophers as the subject of tubercular con- 
sumption, in reference to its pathology and treatment, and yet 
we are compelled to admit that few subjects on which the analyti- 
cal mind of medical philosophy has labored have rewarded our ef- 
forts so little as this ; and we now find in this nineteenth century, 
when every art and science, and our own in particular, is boasting 
of its wonderful discoveries and advancement, consumption still the 
opprobrium of our profession, still the destroying angel for mil- 
lions of our race. This is a lamentable truth ! To realise it we 
have only to turn to the statistics of deaths in any of our large 
cities during any season of the year. And if this is not sufficient 
to satisfy our minds, turn to the various medical periodicals pub- 
lished throughout the world, and see there the reports of fatal 
cases and compare them with those of recovery, and see also the 
various and conflicting opinions of distinguished medical men 
both as to its pathology and treatment. 

In this essay I shall not attempt to follow the beaten track of 
any of the popular theories of the day any further than the estab- 
lished facts of pathological and microscopical anatomy may lead 
me, but will give you the results of much careful observation, 
serious reflection and practical experience. Wherever the views 
taken correspond with those oF others, it will afford me pleasure 
to know that they are confirmed by this experience ; wherever they 
may differ, I shall hold myself responsible for them, and at the 
same time always glad to learn and be convinced of any error. 
With these remarks, I will proceed to consider the subject scrof- 
ula, as manifested in the form of tubercular consumption, in 
regard to its extent, location, duration, pathology, and treatment, 
including hygienic and climatic influences. 

It will be impossible in an essay of this nature to enter into a 
discussion of this disease in all its bearings. To do so would be 



On Phthisis Fuimonaiis. 181 

to extend this essay to volomes. Many important subjects will 
have to be omitted entirely, others hastily passed over. 

In tracing the history of this disease, we find its symptoms 
described by the earliest writers in medicine so clearly that we 
cannot doubt of its existence in their day ; and although they knew 
comparatively nothing of its pathology, and were compelled to 
look through a glass darkly, without the aid of the microscope, 
or the laboratory, or even practical human anatomy and physi- 
ology, it is interesting to observe how closely, in many instances, 
they have approximated to the truth in their theories and specula- 
tions in regard to disease, its nature and treatment. In the 
writings of Hippocrates,* we find the following: 

^' When phlegm falls upon the lungs, or, when the lungs at- 
tract phlegm from all parts of the body, especially the head, they 
become irritated and ulcerated by its adherence and putrefac- 
tion. All the body grows hot and patients spit a good deal of 
this thickened and putrescent phlegm." Speaking of its fatal 
termination, he says: ''It is not possible to fix the time of this 
event ; some lingering a long while, others perishing very soon. 
Concerning the prognostic in these cases ; the sex, constitution, 
time of life and of the year, are to be much considered : in general, 
young persons are oftener and more violently attacked than old 
ones." 

Here we have an undoubted description of tubercular consump- 
tion from the Father of medicine, about 400t years before the 
christian era ; and if its existence at that early period should still 
be doubted by some, the following aphorisms horn him will re- 
move all such doubts : 

«' Oonsumptive persons whose spiitle being thrown on fire 'ex- 
hales an offensive vapor, and whose hair falls, do not recover." — 
Coac. Pr{fe)nj page 176. 

Again: ''When the matter which consumptive persons expec- 
torate sinks in sea -water, it is a sign of speedy dissolution; the 
sea- water must be in a copper vessel." — Coac. Pf^se')nj p. 176. 

It would bo contrary to the object of this essay to enter into a 
discussion of the views of these ancient writers. We would sim- 

* See RioUij't Hlppocmtee, psbUfhed in London, 1789, page 160. 
t Hippocrates* It is believed, wae born at Cot, about 432 B C. 



182 On Phth%8t$ Pulmonalis. 

pi J remark that their philosophy, though crude and often errone- 
ous, yet abounded in many practical hints of great value. Our 
object in introducing these and other passages is simply to trace 
the history of this formidable disease, which we now see prevail- 
ed during the early ages of the world, and then as now too often 
resisted the utmost skill of the physician. 

Dating then from the days of Hippocrates, we might introduce 
quotations and descriptions of the disease from eminent medical 
writers of each succeeding age up to the present date. But such 
a course would not be consistent with the limits or object of this 
essay. Passing, therefore, over the intermediate time, we will 
content ourselves with introducing one more quotation from the 
** Modern Theory* and Practice of Physio" by D. Browne Lan- 
grish of the College of Physicians, London, dated 1738; from 
which some idea may be gained of the state of medical science on 
the subject at that comparatively recent date. 

^^ A cough is the most perplexing concomitant belonging to a 
consumption of the lungs. At first, it is dry, and arises from an 
irritation of the matter pent up in the obstructed glands, as also 
from the stiffness of the nervous membrane lining the bronchial 
pipes, and from the stimulus of the air, which has now too free 
an access to the nervous fibrillse, for want of mucous matter to 
defend them ; but in the progress of the disease, when the ob- 
structed matter begins to digest and corrupt, the serous, watery or 
thinnest parts will of course be squeezed out first, through the excre- 
tory ducts, into the cavity of the bronchial vessels ; and being 
very acid, saline, and sharp, it further irritates the nerves, and 
excites most grievous fits of coughing ; and in the height of the 
disease, when the matter is further digested, and the excretory 
ducts are widened, or when abscesses or ulcers are formed in the 
lungSy the cough is aggravated by a vast quantity of viscous, 
putrid matter, which is discharged into the bronchial pipes. The 
matter which is spit up is sometimes sweet, and at other times 
very fetid, sanious and offensive ; according as it has lain u 
longer or shorter time out of the verge of circulation." 

Prevalence. — ^Perhaps there is no one disease from which so 
many of the human race annually perish as tubercular consump- 
tion. Neither age, nor sex, nor climate, nor season, nor circum- 
stance will protect us from the invasion of this fell destroyer. Yet 



On PhthUit PulmonaUs. 188 

ifc lA foand to prevail to a much greater extent in oertain climates 
and at certain ages than others. In general, the inhabitants of 
a cold dry climate are most exempt from this disease. It is least 
liable to occur in a dry climate, whether warm or cold, providing 
it be not subject to sadden changes. The disease is found to 
prevail least daring the first two years of life, bat increases in 
frequency up to thirty years ; between twenty and thirty the great- 
est number of deaths occur. From thirty, upwards, the propor- 
tional number of deaths from this disease gradually decrease. 

Sex. — ^It has been generally supposed that females were more 
subject to this disease than males ; this supposition was founded 
on statistical observations made in Paris, but more recent obser- 
vations made in other portions of the world render those conclu- 
sions somewhat equivocal. 

Duration. — Tubercular consumption is emphatically a chronic 
disease. Its duration is always indefinite, depending upon a 
variety of circumstances, such as age, constitution, climate, occu- 
pation, treatment, &c. It has been known to terminate within 
eleven days, and it sometimes extends over a period of forty 
years. Its average duration may be stated at from nine to 
eighteen months. 

Symptoms. — The symptoms of this disease are generally suffi- 
ciently marked ; but often, especially in the early stages, they are 
masked and latent, often requiring all the skill of the physician 
to diagnose them. To discuss at length the symptoms and diag- 
nosis of all the multifarious forms of tuberculosis would be tres- 
passing too much upon your time and patience, and at the same 
time contrary to the spirit and design of this essay. Our object be- 
ing rather to investigate the pathology of the disease than to linger 
over the well known and often repeated details of the symptoms 
and diagnosis, which, though of the utmost practical importance, 
every physician is expected to understand. For these, I would 
respectfully refer you to any and all the standard medical authors 
of the day. 

It now becomes my duty to enter upon the discussion of the 
pathology of this disease, and here I beg to remark, that I 
offer these views with all due deference to the opinions of others, 
hoping they will receive your candid and serious consideration. 
No disease has received more attention from pathologists. No 



134 On Phihisii PulmonaKs. 

disease have they labored upon more assidaoaslj to explain and 
understand. Yet, notwithstanding these facts, much concerning 
its pathology and ultimate cause remains in doubt and darkness. 
And it is chiefly to investigate some of these dark points that the 
present essay is written. 

What is tubercular phthisis ? It may be defined to be a disease 
of the organism in general, and of the luugs in particular, ac- 
companied by a deposit of tuberculous matter within the lungs. 
But what is tuberculous matter ? and what is the cause of its be- 
ing deposited in the lungs or elsewhere? Here the-broad ques- 
tion opens before us, and it must be met. In order to arrive 
at a thorough knowledge of disease of any kind, it is not suffi- 
cient to acquaint ourselves with the ordinary symptoms and out- 
ward manifestations, or even with the morbid changes revealed 
by post-mortem examinations. These it is true are valuable 
aids ; they are the mile- stones on the journey, but not the goal 
to which we must attain. We must avail ourselves of these aids 
and all others within our reach, and then subject them to the light 
of reason and philosophy, compare them with other phenomena, 
and mark their connection, and finally trace them to their ulti- 
mate finite source. The human body has been so formed by the 
great Architect, that from the most minute molecule or fibre up 
to the most complicated organs and members, two great distinct 
forces are operating together in harmony and accordance, so 
that in health neither shall interfere with the action of the other, 
but each molecule and organ shall fulfil its distinct and specified 
part in the production of what we are pleased to term life. These 
forces are termed the vital and chemical forces. In order to pre- 
serve the equilibrium of health they must be well balanced. For 
il: one should gain the ascendancy in any organ or part of the 
system, such organ or part of the system will be disturbed in the 
fulfilment of its particular function, and this disturbance react- 
ing upon the organs with which it is connected, and from thence 
acting and reacting upon others, may at length arrest the func- 
tions of all the organs and eventuate in death, unless some more 
potent power should arrest its progress and turn it back into its 
normal state. In the simplest forms of life, whether animal or 
vegetable, we find by the aid of the microscope a simple cell com- 
posed of certain forms of matter and containing within it a nn- 



On Phihisis PubnonaUs. 135 

cleas and nucleoli. This cell is being acted upon bj these two 
forces ; the chemical force whose action alone would be to die- 
solve its present connections and resolve it back into its ultimate 
elements, and the vital force which modifies and controls the 
chemical and so bends its action as to make it subserve the pur- 
pose of growth and development in the cell. Under these circum- 
stances the cell grows and is matured* fulfils its specific and re- 
productive function and passes away or dies, its offspring re- 
maining to fulfil its place and pass through the same changes* 
This, so long as the chemical and vital forces and other condi- 
tions maintain their equilibrium. But if, from any cause, the 
vital force becomes impaired or increased, not su£Scient however 
to arrest the action entirely but to change and modify it, you 
must have a corresponding change in the function and develop- 
ment of the cell. If the vital force is diminished, the growth 
and development of the cell is diminished and its function im- 
paired. Now then returning to the consideration of tuberculosis, 
we find the prominent morbid change to be a deposit of a mor- 
bific matter in the lungs or in some other portion of the body ; 
for convenience, we will suppose it to be in the lungs. But the 
question for us to answer is, where did the lesion commence, 
where did the first link in the chain of morbid action begin ? If 
it be answered that it is a constitutional disease arising from a 
depraved condition of the blood, we claim that the blood is only 
the representative of the formative action of the prima via on 
the nutriment supplied to the stomach. If it be answered that it 
exists in the prima via, the stomach, the liver, or the pancreas, 
and that these organs pour into the circulation ill -elaborated and 
feebly vitalized blood, ( we are supposing the stomach to receive 
its due supply of healthy nutriment, which is often the case in 
hereditary phthisis,) we reply that the healthy performance of 
the functions of these organs depends upon the supply to them 
from the blood of healthy material for their secretions. Post- 
mortem examinations show them to be in a healthy condition. 
60 we cannot attribute the first morbid change to the blood, be- 
cause this is the creation of the prima via; and we cannot at- 
tribute it to the prima via^ for these again are dependent and 
governed by the condition of the blood. 

Again, another class of philosophers might claim that the blood. 



186 On Phthisis Pubnonalis. 

though perfectly formed when poured into the circulation by the 
thoracic duct, by some mysterious process undergoes a degenera- 
tion and loses a portion of its plasticity after entering the circu- 
lation, and thereby becomes unfitted to supply to the tissues 
healthy organizable material for their reproduction and the due 
performance of their functions. Such a yiew must certainly ap- 
pear groundless and untenable, and even the possibility of the mor- 
bid action beginning or existing in the blood when we come to con- 
sider the circumstances of pregnancy in this disease. A woman 
laboring under undoubted phthisis becomes enceinte. The disease 
is somewhat arrested in its rapid progress, and for nine months 
from her own blood she nourishes her offspring, and then gives 
birth to a fine healthy child. Here you have plastic organizable 
material supplied from the blood of a patient laboring under un- 
doubted consumption and resulting in a fine healthy chiid. What 
could be more conclusive than this 7 What further proof could 
be asked to relieve the blood of such a charge. 

But still the question presents itself, where did the first link in 
the chain of morbid action begin ? It did not begin in the blood. 
It did not begin in the prima via. It must then have begun in 
the tissues themselves, and this, gentlemen, is where I really be- 
lieve it does begin. Let us return again to our philosophy of the 
cell. The simple cell may be regarded as the representative of 
all organized tissues. Indeed a large portion of all organized 
tissues is known to be formed of innumerable cells, and what is 
true of one of these cells is applicable to all. We have seen how 
important it was to the healthy performance of all its functions 
that the equilibrium between the vital and chemical forces should 
be strictly maintained. Now, let us suppose for a moment that 
in one or more of these infinitesimal cells, situated in some ob- 
scure portion of the lungs, from some cause, of which there might 
be many, the vital force by which it is governed becomes impaired 
but not destroyed. The inevitable consequence of such an im- 
pairment is a perversion of its function. That function may be 
secretion and reproduction or excretion ; but whatever it may be, 
it is perverted, its motion is changed, and from developing natu- 
ral products it begins to develop unnatural products. Kow bring- 
ing to bear upon this point the law long since proposed by La 
Place and Bertholet, and since most ably adopted and proved by 



On Phthisis Pulmonalis. 137 

Lcibig, that '^ a molecule set in motion by any power can im* 
part its own motion to another molecule with which it may be 
in contact ;" and we have a clear explanation of the means by 
which the impairment and perversion of the function of a single 
cell may be commanicated to many ; and instead of the unnatural 
products of a single cell we may have the unnatural products of 
many. These products may assume the form of tubercle or any 
of the other unnatural deposits so often found in the body as 
circumstances may govern. Having once established the means 
by which such a deposit may be formed, and such, a morbid ac- 
tion established, we can easily understand how the circulating 
medium may from time to time float off loose molecules of this 
perverted material and afterwards lodge them in some of the 
minute capillaries of other tissues, where, according to the same 
law they would establish the form of perverted action peculiar to 
themselves ; and in this way the disease would soon become gen- 
eral, or in other words constitutional, and all the concomitants of 
tubercular consumption rapidly develop themselves. 

Causes. — ^In considering the causes of this disease, it must 
now be evident that any thing calculated to impair the vital force 
either generally or locally, directly or indirectly, is entitled to 
rank as a cause of this disease. These may be divided into in- 
trinsic and extrinsic. The intrinsic, including all those causes 
acting from"^ within the body, while the extrinsic consist of all 
those debilitating influences acting from without. Among the in- 
trinsic causes probably no one is so general or so difficult to over- 
come as hereditary taint. In some of these cases the chemical 
and vital forces that unite the elements of the cell growth of or- 
gans seem to be so delicate that the slightest external influence 
may disturb their equilibrium and give rise to that perverted func- 
tion which once established, according to the laws of molecular 
motion, is almost certain soon to become general ; and it is in 
these cases where these two great forces are so delicately balanced 
that this perverted function being once established is sure to 
spread with the greatest violence and activity. In other cases it 
would seem that the ultimate cells and tissues had been endowed 
with a vital force capable of conducting their functional revolu- 
tions for a certain length of time, when, having finally exhausted 
its power, chemical forces begin to gain the ascendancy, accompa- 



188 On Phihists Pulmonalis. 

nied by those morbid prodacts of perverted fanction which speed* 
ily extend and increase until the whole or a large part of the 
organ is destroyed. Either of these conditions may be transmit- 
ted from parent to offspring on the principle that like produces 
like. I would not be understood to ignore the effects of a morbid 
product accumulating in a tissue and thereby acting as a foreign 
substance, developing inflammation and all its untoward results. 
These things would be referred to and discussed more extensively, 
but time and space will not permit. 

The existence of the disease in the parent is not always essen- 
tial in order for Its transmission from parent to child. There 
are a great many diseases which so impair the vital forces in the 
parent as to render them incapable of reproducing offspring in 
whom these vital forces exist in their normal extent and activity. 
Among these may be mentioned secondary syphilis. The injuri- 
ous effects of long courses of mercury ; long continued disease 
of the digestive organs, &;c., &c. 

In short, any thing which impairs the vigor of the vital force 
acting in the ultimate tissues, renders them unqualified to repro- 
duce like tissues in which this vital force exists in its wonted equi- 
librium. The explanation of these phenomena becomes plain and 
easy when viewed in this light, whereas in any other they must 
always remain a source of doubt, darkness and uncertainty. 

Among the remaining intrinsic causes, may be mentioned all 
other diseases that have been or may be operating in the system 
and are calculated to impair or overcome the vital force acting 
in certain tissues, and thereby establish a perverted action in 
them. 

Passing then to the extrinsic causes, they may be defined to 
consist of all those outward circumstances which, acting upon the 
individual either locally or generally, are calculated to diminish 
and weaken the vital forces which govern the functions of the 
ultimate tissues, thereby perverting their function and developing 
morbid plastic deposits. Among these, may be enumerated : im- 
pure air, unwholesome diet, deficient or excessive exercise, impro- 
per clothing, want of cleanliness, intemperance and exposure. 
It would be extending this article to too great a length if we were 
to undertake to explain here the manner in which all these circum- 



On Phihisvt Puimonalis. 189 

stances operate to prodace these results, although it would be an 
interesting enquiry. 

Varieties, — ^It will be sufficient for our present purpose to 
divide tuberculosis into two distinct varieties, i. g., hereditarj 
and acquired. All the other divisions made bj authors may be 
included under these heads : they are generally peculiarities and 
modifications produced by local circumstances, variations of con- 
stitution, occupation, &c., rather than distinct varieties of the 
disease. 

Treatment. — ^The subject of treatment may be considered un- 
der three distinct divisions ; namely, prophylactic, curative, and 
palliative. 

In accordance with the views heretofore taken of the pathology 
of this disease, it will be evident, that our object in the prophy- 
lactic treatment will be to maintain and husband that vital force 
which we have seen is so essential to the ultimate tissues in the 
performance of their normal functions, thus avoiding the deposit 
of the first unnatural product in the tissues, and thereby breaking 
the first link in the chain of morbid action. And here it may be 
remarked, and almost every practical physician will bear me out 
in the assertion, that in our prophylactic treatment rests almost 
all the success that has ever attended the efforts of medical men. 
The importance then of giving it the most careful thought and 
early attention cannot be too highly estimated. Unfortunately, 
our limits will not permit us to dwell upon the subject of treat- 
ment ; we will endeavor, however, to point out some of the land- 
marks by which we are to be governed. When we are called 
upon to take charge of an individual in whom we have reason to 
fear an attack of tuberculosis, our first duty to him is to sur- 
round him by all the circumstances that experience has shown to 
be most conducive to the highest amount of physical health, there- 
by affording the organization vital power to resist the action of 
those debilitating influences from within, or from without, that 
may be tending to disturb the just equilibrium between the vital 
and chemical forces. This is to be accomplished by the most 
careful attention to climate, air, exercise, diet, bathing, frictions, 
occupation, mental condition, and all those other hygienic rules 
and regulations which are so justly regarded as conducive to a high 
degree of physical health. A dry equitable climate would at this 



140 On PhthUis Pulmonalis. 

time be most advisable. Change of scenery and moderate exer- 
cise in the pare open air must be regarded as most important 
measures. A moderate amount of exercise, so taken as not 
to exhaust the system, and yet secure to all the organs a de- 
cided action, should be taken daily. The diet should bo nour- 
ishing but of easy digestion, so as not to overtax the powers of 
the digestive organs. The meals should be taken at regular 
hours. Avoid gross meats, especially swine's flesh. A glass of 
generous wine, or ale, will often be found of great benefit after 
eating. The sponge or shower-bath daily, followed by active 
friction with a coarse towel, are almost always decidedly bene- 
ficial ; care should be taken that the body does not become chilled 
by keeping it wet for too long a time. A moderate and pleasant 
occupation affords exercise and promotes a cheerful disposition, 
which is most desirable in cases of this nature. All depressing 
mental emotions and unnatural excitements must be avoided. 
The clothing must be regulated so as not to be too warm, and yet 
to afford sufficient protection. But we cannot permit ourselves to 
enter further into these details. The judgment and knowledge 
of the physician must aid him in applying this treatment to indi- 
vidual cases, according to age and circumstances. 

Curative Treatment. — ^We have little to offer on the subject 
of the cure of tubercular consumption. We frankly confess that 
we know of no specific remedy for this disease when the perverted 
action has once begun. Many medicines have been proclaimed 
at different ages of the world as specifics in this disease, but none 
of them have stood the test of observation and experience. Ac- 
cording to the pathological views hereinbefore explained, and re- 
garding the first link in the chain of morbid action as being a 
disturbance of the equilibrium of the chemical and vital forces in 
the ultimate molecular structure of the organ, thereby causing 
perverted action and morbid aspect, — it is evident that our object 
should be to arrest the progress and extension of this perverted 
action ; to draw a line of demarcation between the diseased and 
healthy tissue ; and, finally, to promote its elimination from the 
system. But how these things are to be accomplished remains 
for future labor, future thought, and future investigation, to de- 
termine ; and whoever shall discover the means by which they 
may be brought about and health restored, shall weave a wreath 



On Phthisis Puimonalis. 141 

of nnfftding laarels to adorn his brow. Perhaps, in those reme- 
dies which have a tendency to arrest decomposition and decay, 
such as the empyreumatic oils, coffee, tea, and the varions alco- 
holic preparations, valuable aids may be found. Although we 
know of no specific cure for consumption, we would not be un- 
derstood as holding the position that recoveries do not sometimes 
take place. In cases where this disease had undoubtedly existed, 
such recoveries have been known ; but such cases are the excep- 
tion and not the rule, and probably owe the favorable change as 
much to the vital forces of the organization as to any remedial 
agents that have been administered. 

Pallialives. — ^Although it is not yet in our power to specifi- 
cally cure this disease, it is in our power to support and maintain 
the flagging powers of life, to relieve local complications that may 
arise in the course of the disease, and which if allowed to pro- 
ceed unchecked would speedily bring about the fatal termination. 
We can alleviate our patient's sufferings, guard him against im- 
proper exposures or habits, and surround him by all the circum- 
stances calculated to husband the vital forces, and postpone the 
fatal end. In this way, his life may be prolonged in comparative 
comfort often for many months or even years. The manner by 
which these things are to be accomplished, and the means to be 
employed, are numerous and varied. To discuss them here would 
be to extend this paper over many more pages and trespass too 
long upon yonr time and patience. Every judicious and enlight- 
ened practitioner is expected to understand them, and they are 
fully taught and explained in all the standard text books of the 
day. On some points, however, differences of opinion will arise, 
and it would have afforded me great pleasure to have entered into 
a detailed investigation of this interesting subject, especially in 
regard to the effects of climate and its proper application to the 
different stages of the disease. 

We will conclude this essay, therefore, by once more calling 
your attention to what we must regard as the first link in the 
chain of morbid action. Here is where we meet the enemy face 
to face ; and here is where, if ever we do succeed, the battle is to 
be won. Strike at the root! break the first liuk in the chain, 
and the victory is ours. Let physicians then direct their energies 
to this point. Let them search among the secret and hidden 



142 BibliagraphiecU Notices. 

things of nature for some talisman by which this first perverted 
function may be arrested and removed, and when it is found, we 
may truly cry Eureka ! 



PART II. 

REVIEWS AND BI BLIOGR APHS. 

ARTICLE I. 

Prize Essay: ** To what Affections of the Lungs does 
Bronchitis give origin f^^ By Daniel D. Sladb, M.D., 
of Boston, 

To this essay was awarded the prize offered by the Massachu- 
setts Medical Society. It is well written, and carefully compiled, 
presenting all the most recent investigations on the subject. The 
author does not '* presume to offer any thing which does not 
already belong to science," but has carefully studied the writings 
of Laennec, Legenillre and Bailey, Oairdner, and others, and has 
given a well digested restimS of their observations. The essay 
is confined almost entirely to the pathological conditions.observed 
in the lungs — ^the symptoms of the diseases, both rational and 
physical, being only briefly noticed, and the therapeutics not at all. 
He describes, first, the appearances of bronchitis, the congestion 
of the mucous membrane, loss of epithelium, and the change in 
the character of the secretion. He next discusses the nature of 
post-natal atalektasis, or collapse of the air cells, and the causes 
which give rise to it, following the descriptions and explanations 
given by Legendre and Bailey, and by Dr. Gairdner, that it arises 
from plugs of mucus obstructing the bronchial tubes in sucli a 
manner as to allow free egress to the air contained within the vesi- 
cles, but to prevent its entering again with the inspiration. It 
occurs especially in debilitated children ; the same condition how- 
ever may be observed in the adult, and is not at all uncommon in 
those far advanced in life. Bronchitis often produces pneumonia 
both lobular and lobar. Abscesses sometimes form in the neigh- 
borhood of the bronchi, afterwards giving rise to dilatation of 



Bibliographical Jfblices. 148 

these tubes. The author then passes to the secondary and more 
permanent lesions that result from bronchitis ; atrophy from col- 
lapse, vesicular emphysema, obliteration and dilatation of the 
bronchi. In the first two, he follows closely the well-known de- 
scriptions of Dr. Gairdner, and is disposed to agree with him as 
to the mechanism by which emphysema is caused, viz., by the 
expansion of the air cells during inspiration, and after a shrink- 
ing of part of the lung from collapse, healing cavities, or other 
causes, has already occurred. He, finally, reviews the connection 
between bronchitis and spasmodic asthma and phthisis. Bron- 
chitis, he says, '^ plays its part most frequently in the production 
of the former disease, or at least it is the exciting cause of the 
asthmatic paroxysm in the great proportion of cases." With re- 
gard to phthisis, after quoting the opinions of Louis, Andral, and 
Dr. J. Clark, and the statistics of Drs. Pollock, Leared, Briquet 
and Gellersted, he comes to the conclusion, ^' that the popular 
notion that tubercular phthisis is the common and direct result of 
bronchitis, or, in common parlance, of a ^^cold," is not founded 
upon fact, and that this affection is to be considered as a cause of 
phthisis onlj/ when a predisposition exists.^^ M. 



ARTICLE II. 



Sixih Segialralion Report of South Carolina. By R. W. 
GiBBBS, Jr., M.D. 

Every person who understands what registration means, can 
not fail to appreciate the great advantage of a systematic and 
accurate record of births, marriages and deaths, but so far, in 
this country, but few have given the subject any attention. If it 
be important to record the title to every piece of property, to 
note the changes in wealth and greatness of every community, 
surely it is equally necessary to note the births, marriages, and 
deaths of individuals composing that community and controlling 
that property. If it be beneficial and philanthropic for physi- 
cians to prevent as well as relieve sickness ; to prolong the lives 
of mankind, and to promote the health and wealth of the commu- 
nity in which they live, it is desirable to have accurate statistics 



144 Bibliographical Notices. 

for making medical and sanitary inqniries. This report has been 
compiled with great care and trouble, and furnishes much useful 
information. Among other things, it shows that the growth of 
population in South Carolina has been very slow compared with 
our western States, and that the rate of increase in the white popu- 
lation has steadily diminished since 1790, whilst that of slaves has 
proportionately increased, while the free colored has not materially 
changed. In 1790, the Palmetto State had 6.34 per cent, of 
the whole population of the Union, but in 1850 it had diminished 
to only 2.88 per cent. K. 



ARTICLE III. 



On Diphtheria. By Edward Headlam Greenhow, M.D., 
Fvllow of the Royal College of Physicians ; Physician to 
the Western General Dispensary^ and Lecturer on Public 
Health at St. Thomas^ Hospital, JVtw York: Bailliere 
Brothers, 440 Broadway. 1861. 

This small volume, of one hundred and sixty pages octavo, is 
the republication of a recent English work, on this most interest- 
ing disease. The wide- spread prevalence of diphtheria in this 
country, the comparative novelty of the disease itself, and the 
great interest which attaches to it, on account of its extreme sever- 
ity in many localities, all conspire to render this a most timely 
publication. Physicians throughout the country naturally desire 
to inform themselves as to the history, nature, and best method 
of managing a malady with which they are confessedly not 
familiar, growing out of the fact of its recent re- development. 
In this desire we know that many of our readers share, and it is 
therefore with pleasure that we call attention to it. The author 
has had ample opportunity of observing and studying the dis- 
ease, both in public and private practice ; and he has besides 
availed himself of all the means within his power of acquiring 
practical and reliable information from those who have been most 
extensively engaged in its treatment. It may, therefore, be re- 
garded as a fair exponent of the present state of professional 
knowledge on the subject of diphtheria. In order that our read- 
ers who may wish to procure the work for themselves may have 



Bibliographical Notices. 145 

an idea of its scope, we subjoin the captions of the twelve chap- 
ters into which it is divided. These are, 1st. Preliminary Obser- 
vations — ^Definition of the Disease ; 2d. Diphtheria in the Six- 
teenth, Seventeenth and Eighteenth Centnries ; 8d. Diphtheria in 
the Nineteenth Century ; 4th. As a Sporadic and Endemic Dis- 
ease; 5th. Non-identity of Diphtheria and Scarlet Fever; 6th. 
Hnman and Brutal Diseases co-incident with Diphtheria — ^Rela- 
tion of place, age, sex, and social position to the Epidemic ; 7th. 
Gommunicability of Diphtheria ; 8th. Symptoms — Description of 
the several grades and varieties of Diphtheria ; 9th. Symptoms — 
Diphtheria on the Outaneous Surface and Wounds — Occasional 
Concomitants of the Disease, and Manner of Death; 10th. Symp- 
toms and Sequelae of Diphtheria ; 11th. Morbid Anatomy of 
Diphtheria, and 12th. Suggestions for Treatment. 

As far as we have been enabled to examine the work, these 
subjects are dearly and intelligently treated of, and the author 
has collected much valuable information, and made many useful 
and practical suggestions. Those who wish to get the work can 
do so at a cost of one dollar and twenty-five centSj by ap- 
plying to the publishers, whose address is given above. 



ARTICLE IV. 



Hessling 4* KoUtnann^s Jillas qf OenercU ^Snimcd Histology* 
Photographs from JVhture. Bj Josbph Albbbt. Svo. 
Leipsicj 1860, No. 1. — [Hessling & KoUmann, Mlas der 
allg, thier. Oewebelehre. JVhch der JVlUur photographist 
von Jos, Albert.'] 

We have before us a work of an entirely novel character. The 
*^ Atlas of General Animal Histology," of which the first number 
has reached us, will illustrate objects of general anatomy by 
forty- two photographic pictures taken directly from the micros- 
cope by the well known artist of Munich, Albert, which are ex- 
ecuted in the very best style. This is the first attempt to bring 
the photographic art into the service of science, and the advan- 
tage ^of this mode of illustration cannot be overestimated. We 
have been accustomed to receive the images of the microscope 
not as they really ara, but as the observer recognized, understood, 
Vol. XIX — 10 



146 Bibliographical Notices, 

explained them. All former drawings from the microscope, even 
the wood-cut copies of photographs, which we find in Draper's 
Physiology, etc., gave only that which the artist believed he saw ; 
all contained the explanation of the image, as given by the micros- 
copist ; whereas, this new work furnishes the image as it pre- 
sents itself tto the eye of every one ; we look, as it were, into the 
microscope ourselves in contemplating the picture, and are thus 
enabled to judge for ourselves, to form our own conceptions, 
and to make our own explanation of the object. Hessling and 
KoUmann's Atlas supplies in some measure the microscope to 
those who do not possess one, and furnishes the typical images 
of the most common objects to those who are in the habit of stu- 
dying histology themselves, containing the elementary forms of 
animal tissues in truthful and natural representation. 

Among the objects which the present number (eleven plates) 
elucidates, we must notice for their extreme beauty and distinct- 
ness especially the four plates of blood corpuscles (of man, bird, 
reptile and fish), a photograph of epithelial cells from the mouth, 
and two representations of bone corpuscles (from man and fish). 
The succeeding numbers, which are to be issued at an early day, 
will give us pictures of the cells of pus, lymph, connective tissue, 
of cartilage, nerve- fibres, and nerve- cells, etc. 

The pictures themselves are {round, of course, like the field 
of vision in the microscope) about three inches in diameter, 
surrounded with a square black margin and pasted on large 
octavo leaves of thick white paper ; at the bottom of which we 
find the name of the object and the magnifying power employed. 
The latter usually is 850 diam., in one instance only (in the 
present number) 850 diam. 

The atlas will not be accompanied by any text, and the names 
of the objects at the bottom of each plate are in German, French, 
and English, so that the work is serviceable to scientific men in 
this country and England, as well as in Germany and France. 
The price, moreover, is exceedingly moderate (^5.00 — 6.50 for 
the complete work), and renders it accessible to all. G. B. 



Bibliographical Notices. 147 



ARTICLE V. 

A Hand-book of Hospital Practice^ or an Introduction to the 
Practiced Study of Medicine ai the bedside. By BoBsaT D. 
Lyons, Physician to Jervis street Hospital, Dubliny if^., 
Sf^c, Samuel S. <V Wm. Wood, 889 Broadway, M". Y. 

It is impossible to become an adept in any business or profes* 
sion withoat mnch practical and methodical experience ; and in 
medicine, where mnch of oar knowledge can be gained only by 
personal observation and critical bedside examination, it is vain 
for as to expect to be jadicioas and saccessfal practitioners un- 
less we systematically, indastriously, and perseveringly watch and 
stady the cases under our charge during our hospital pupilage. 
We can never gain the necessary knowledge from books alone, 
nor from attendance upon hurried diniques, but must have im- 
mediate charge of the sick, be subject to the close supervision of 
learned and experienced men, and patiently watch and record 
every case of importance. If our medical education be conduct- 
ed in this manner, we may commence practice with confidence 
and benefit both to our patients and ourselves ; but if not, we 
will constantly meet widi embarrassment and disappointment, 
and be of but little use to humanity or our profession. 

With the view of directing clinical study and aiding the student 
in systematizing his knowledge and reducing it as far as practi- 
cable to a scientific system, the author has written this volume, 
which, though of necessity unattractive in style, contains much 
that is invaluable to the young practitioner, and of great impor- 
tance to every medical man. It gives general directions for the clin- 
ical examination of patients ; tells us what we must expect to find 
in the normal and abnormal state of every viscus of the body ; 
what effects their derangement produce upon the whole system, 
and what the peculiar symptoms in each case signify and point 
to, whether in disease of the brain, lungs, heart, or whole econ- 
omy; what we can learn by percussion and auscultation, and 
how each is to be practised ; how to make and what is to be gain- 
ed from an examination of the secretions and excretions. It also 
contains directions for making scientific post-mortem examina- 



148 Cure of Cutaneous Diphiheria. 

tions ; explains how this very necessary performance can be ac- 
complished in an easy, cleanly, profitable and instruetive manner, 
so as to'determinethe cause of death, and ascertain with accuracy 
the pathological lesions peculiar to each disease. In the appen- 
dix, we find correct rules for writing prescriptions in a classical 
manner, and also forms for recording cases. E. 



PART III. 

RECORD OF MEDICAL SCIENCE. 

Cure of Cutaneous Diphtheria by Perchloride qf Iron. 
By RoBBBT HuNTEK Sbmplb, M.D. 

The following case is doubly interesting, both as an example 
of the effect of a mustard- plaster on the skin, under the influence 
of a diphtheric epidemic, and as an example of the good effects of 
the internal and external use of perchloride of iron. A man, 
forty- two years of age, of a strong constitution, was seized, in 
November, 1859, with a subacute form of bronchitis, and as he 
became delirious in the course of the complaint. Dr. Noir, who 
was attending him, ordered mustard- plasters to the calves of the 
legs. The delu-ium ceased, but the mustard produced a vesica- 
tion, which disturbed the patient all night. The next day Dr. 
Noir opened the vesicles without removing the epidermis, and a 
quantity of serum escaped, similar to that of blisters. There was 
great subsequent irritation however, and Dr. Noir, investigating 
the cause of the patient's sufferings, discovered, instead of vesi- 
cles, two enormous diphtheritic patches, one on each calf; these 
patches were of a greyish-white color, irregular and dry, suffi- 
ciently hard to give a sound when struck by a spatula, both sur- 
rounded by an erysipelatous areola, tending to enlarge, and more 
painful than the patches themselves. There were at the time 
several cases of diphtheria among children in the neighborhood. 
Dr. Noir cauterized all the areolae with nitrate of silver, in order 
to prevent the disease from spreading; and he also ordered a 
draught to be taken, containing twenty drops of tincture of per- 
chloride of iron at frequent intervals. The diphtheritic patches 
and the inflamed skin surrounding them were washed with a solu- 
tion of iron. By this treatment, the progress of the disease was 
arrested and the pain was relieved, and after a few days a deci- 
ded improvement was manifest. The diphtheritic patches were 



Quinine and VercUria in Typhoid Frver. 149 

gmdoally thrown off, snd eventually two nloers of a healthy ap- 
pearance were left, which proceeded to cicatrization without any 
serious symptoms. — Gazette dea HdpUaux. — BrU. Sr For. 
Med. Chir. Rev. 



On the Employment of Sulphate qf Quinine and Ferairia in 
Typhoid Fever. By Dr. Vogt. 

Dr. Yogt has collected and tabulated a number of cases of 
typhoid feyer treated by sulphate of quinine and by yeratria, and 
although the cases treated by the latter alkaloid were few, he 
prefers it on the whole to quinine as a remedial agent. He re- 
gards both alkaloids as valuable in the treatment of typhoid 
fever, but thinks that they are useful in different stages or con- 
ditions of the disease. The action of veratria, he says, is more 
direct, causes no excitement, and proceeds especially from the 
ppinal cord ; that of quinine proceeds principally from the brain, 
and cannot be manifested in a short time without previous excite- 
ment. Hence veratria is to be preferred in all febrile diseases 
which show a rapid and impetuous progress. In typhoid fever it 
should be employed at the commencement, more particularly 
when the fever is very acute and the congestion in the head very 
active. In cases which are more slow in their progress, with a 
less intense febrile reaction, with hyperemia more dependent on 
venous sti^ation, and in the latter periods of the disease, when 
ansBmia or adynamia predominates, then quinine is preferable. 
In some oases, both remedies may be employed, the veratria be- 
ing administered first, and the quinine afterwards. The antipy- 
retic power of veratria is greater than that of quinine ; for, where 
the latter has failed, the former often succeeds in a very extraor* 
dinary degree. In the eruptive fevers, whenever their tendency 
is to a true inflammatory localiEation, or when Ais localization 
has already happened, veratria must be selected, from its singu- 
lar efficacy in pneumonia and puerperal fevers with intense local 
inflammation. But if, on the contrary, the fever is idiopathic, 
and entails no local inflammation, quinine should be employed. 
The toxical action of quinine is more marked and more difficult to 
avoid than that of veratria. In order to attain to the antipyre- 
tic effects of quinine, it is necessary to administer the alkaloid 
till it produces the peculiar noises in the head, and although these 
noises are anticipated, they are the more worthy of attention^ 
inasmuch as the vomiting produced by veratria is more frequently 
beneficial than injurious. Veratria, says Dr. Vogt, possesses, in 
typhoid fever, a power far superior to that of quinine in relieving 
the head) especially in the first stage of the disease. But if the 



160 Treaimeni of BeUtUion of Urine. 

wtodton of tba bead depends vpon Tenoos eongestioiiy ^pnhie 
IMJ iseeeed better tbsa feratria. In % general manner it may 
be atated ibat Teratria deserres tbe preference in many cases as 
an anttpyretic; and as to tbe otber indications for tbese two 
remedies, qoinine ougbt to be preferred in marsb-feyers with a 
moderately rapid progress, and in otber febrile diseases wbich 
bare reaebed an advanced period, especially when anaemia and 
adynamia bare already commenced, and especially when it is not 
essential to interrupt tho febrile action in a shorter period. 

[BuUetin General de ThSrapeuizque.—Ibid. 



On the Ute qf Ergot of Bye in the treatment of Retention of 
Urine from Paralyiis of the Bladder. By Dr. Allier. 

The faonlty possessed by ergot of rye of producing uterine 
contraction suggested to Dr. Allier the idea of employing this 
ogent in the treatment of certain forms of paralysis of the blad- 
der ; and M. Paul Quersant has subsequently demonstrated in 
hii practice at the Bicdtre, that the ergot is really endowed with 
the property of exciting contraction of the bladder. He employed 
it not only in cases of retention of urine from simple paralysis of 
the bladder, but also in order to promote the expulsion of the de- 
tritus ot calculi after lithotrity. In order to ascertain the physi- 
ological effects of this substance, Dr. Allier took several times, 
fasting, one gramme divided into four doses ; the results were a 
little heaviness of the head, and a slight feeling of intoxication 
similar to that produced by champagne. Sometimes there was 
a desire to make water more frequently than usual, almost always 
a kind of uneasiness in the pelvic organs, which prevented sleep ; 
at other times, on the following night, there was a kind of invol- 
untary jactitation and disturbed sleep, and the rhythm of the 
heart's pulsation was variable. Dr. Allier relates a number of 
cases treated by ergot of rye, and his general conclusions are as 
follows : In the first place, he finds that tbe innonous character 
of the drug is fully established, although he administered it in 
laree doses continued for a long time, and be is therefore induced 
10 doubt tbe deleterious effects attributed to it by some writers, or 
rather be believes that there may be different kinds of ergot, 
some of which are poisonous and others not so. In four out of 
fourteen eases related* there was erident exdtement of the gen- 
erative organs, wbich eould be attributed only to the we of tbe 
ergot, and neariy all the eases exhibited more or less alteration 
in tbe nervous system, tbe most constant effects being a kind of 
pleasing inebriation* itching of tbe skin, nausea, uneasiness in 
ttie low«r limbs, slight convulsive movements, and a^eeiaily ex* 



Chlorate of Poitusa in OonorrhcRa. 151 

citement of the contractility of the bladder when this function had 
been weakened or lost. The ergot appears especially to have a 
kind of mysterious predilection for the bladder, of the same na- 
ture as that which is admitted to exist in the case of the uterus, 
and quite as inexplicable ; it is, in fact, a special and transient 
exciter of the nervous system, appearing to act more particularly 
upon the lumbar portion of the spinal cord and the hypogastric 
plexus of the sympathetic, which themselves react upon certain 
orders of muscles, and especially on those of the bladder. Dr. 
Ailier does not agree with M. Bonjean in classing ergot among 
the opiates ; for, according to the former physician, ergot never 
produces stupefaction, such as is observed in advanced druuken- 
ness, or in opium-smoking, and opium- eating. The transient in- 
toxication produced by ergot can only be compared to the effects 
of a glass of champagne. It may be admitted, however, that one 
of the principles of ergot, namely, ergotinej may present some 
analogy with opium in its stupefying power. Dr. Ailier draws 
the following conclusions from his researches : Ergot overcomes 
retention of urine when it has not yielded to catheterism, and 
abridges the duration of those cases which would yield in time to 
the catheter. It has no efficacy in the treatment of retention 
caused by enlargemenc of the prostate. Paralysis of the blad- 
der, resulting from cerebral hsemorrhage, yields rather easily to 
ergot; but this is not the case with paralysis of the limbs follow- 
ing apoplexy. Ergot is equally efficacious in vesical paralysis 
connected with an undetermined lesion of the nervous centres, but 
has no power over paralysis of the limbs dependent on the same 
lesion. — Ibid. 



Chlorate of Poiassa in Gonorrhoea. — The following is horn 
the Med. & Surg. Reporter: "Dr. Irwin, U. S. A., stationed at 
Fort Bnchanan, says, ' it may not be amiss to place on record 
my testimony in favor of the use of chlorate of potash as a thera- 
peutic agent, which I have constantlv used during the last two 
years in the treatment of gonorrhoea, both in my public and pri- 
vate practice, with the most gratifying results. I have found it 
to be such an admirable remedy that I seldom resort to any other 
in the treatment of urethral inflammation. My meihod of using 
it is as follows : one drachm of the salt dissolved in eight ounces 
of water, of which an injection is given every hour for twelve 
hours, at the end of which the discharge will have become changed 
and diminished, allowing the remedy to be gradually discontinued 
until the second or third day, when the disease will be generally 
found to have ceased. So efficacious has this remedy proved in 
my practice, that I seldom deem it necessary to give any other 
medicine, save a Seidlitz draught or a dose of Epsom salts.' " 



162 Treatment of Tape- worm. 

jSromaiic Sulphuric Jieid in the Treatment of Tape • worm. 
By B. Darrach, M.D., Quincj/j IB. 

Taenia bas preeminently its fashionable remedies. Konsso, 
after being lauded as a certain cure, and sold at extravagant 
prices, has been laid aside, like many of its predecessors. Emul- 
sion of pumpkin seeds, I apprehend, is destined to the same fate. 
I have seen it fail in a case, where a year before it had expelled 
twenty- four feet of the parasite, and where turpentine was sub- 
sequently used with success. Will the profession then pardon 
me if I bring another remedy to their notice, that it may have a 
trial which alone can test its value. I am indebted for the facts 
to my fellow-practitioner. Dr. Adams Nichols, and publish them 
with his concurrence. 

*^ On the 6th of February last, the doctor was called to see 
Mr. P , farmer, aged about thirty-five, native of this vicin- 
ity, and living a few miles from town. He had been suffering 
for three months with vague pains in different parts of the body ; 
was debilitated and emaciated; had some cough; a slight ex- 

Sectoration, and obstinate constipation. When I saw him for the 
octor on the 10th, he had the appearance of a phthisical patient. 
On Dr. Nichols' second visit, the patient exhibited a discharge 
from his bowels which had alarmed him ; to use his own expres- 
sion, *hi8 bowels were all coming away from him.' Upon inspec- 
tion, the discharge was found to be a mass of tape- worm several 
feet in length. He was ordered aromatic sulphuric acid ^ j., 
water Oiss ; to drink of it as often as he could until he had used 
it all. On the third day he passed about a pint of the worm in 
fragments, and apparently partly digested. The dose was re- 
peated on the fourth day as a precaution, but without expelling 
any more of the animal. 

^^ Feb. 24th. Beported himself ; bowels regular ; cough gone ; 
appetite good ; gaining flesh, and no symptoms of the worm. 

<< Since the above date he has entirely regained his flesh and 
strength, and has perceived no indication of a return of the par- 
asite." 

The above remedy was brought to the doctor's notice in rather 
a singular manner, about thirty years ago, while practising on 
Cape Ann, Mass. An old woman sent for him one afternoon to 
visit her, and greeted him on his arrival with the announcement, 
"Doctor, I've got a tapeworm!" The doctor not finding any 
very satisfactory evidence of the presence of such a creature, tried 
to laugh her out of the idea, and left her. A few days after he 
was summoned agnin, when she told him — "Doctor, I've killed 
my tape-worm, and there he is !" showing a vessel half filled with 
the animal. On enquiry as to what killed it, she replied, "Well, 



Use of the Oxalaie of Cerium. 158 

I felt him poking his nose np into my stomach again this morn- 
ing, so I took a teaspoonful of elixir of vitriol. I thought that 
was the sourest thing I could find, and gave it to him for his 
breakfast." Subsequently, the doctor met with two other cases 
on Gape Ann, and profiting by his experience in the case of the 
old woman, treated them successfully with the acid, giving 3 j, in 
several ounces of water in the course of three or four hours. 

A few years ago, in this city, Mrs. M , a feeble woman. 

Laving kept her bed for five months, and at the time very low 
from a recent confinement, was surprised one morning by the 
passage of about five feet of tape-worm. Turpentine was admin- 
istered tor two days, without success. The acid, which had for 
the time been forgotten, was then given, three teaspoonsful in 
twenty- four hours, in sweetened water, when a Ions worm was 
expelled. The patient speedily regained her flesh and strength. 

All of these cases, excepting the first, remained under obser- 
vation for some years, without any return of the worm. In all, 
the discharged worm was in the same fragmentary and semi- 
digested state. Finally, the doctor says, the remedy has never 
failed with him. — ^mer. Jour, of the Med. Sciences. 



On the Therapeutical Use of the Oxalate of Cerium. By 
Chas Leb, M.D., House Physician to Blockky Hospital. 

About a year since, Prof. Simpson of Edinburgh first called 
attention to the medical use of this preparation, heretofore rarely 
known, even in the chemist's laboratory. Presented under such 
high authority, it is not surprising that in a few months tl^ere 
should be made, both in Europe and America, numerous trials of 
its efficacy in different gastric affections. It was used by Prof. 
Simpson, so far as I can learn, only in the vomiting of pregnan- 
cy. {Med. Times Sr Gaz., Sept., 1859.) But more recently 
it has proved useful in so much wider a field, that it promises to 
assume a permanent place among the mineral tonics, and, as such, 
some account of its therapeutic application may not prove unin- 
teresting. 

As regards the preparation itself, but few words are necessary. 
Its base, cerium, was first isolated by Berzclius and Hisinger, in 
1809 ; together with lantbaniom and didymium, it is obtained in 
considerable amount, as the mineral, cerite, from the mines of 
Sweden ; and in this country it has been found, in the mineral 
allanite, in the interior of New York, and near Bethlehem, Pa. 

From either of these sources it may be obtained by means of 
the mineral acids, and sulphuretted hydrogen at a high tempera- 
ture, and finally precipitated by a solution of oxalic acid, as de- 



154 U$e of ihe Oxalate of Cerium. 

scribed in an interesting paper by Mr. Meyer of New York. 
{Aniet. Jour, of Pharm.^ January^ I860.) 

As thus obtained, the preparation is a white granalar powder, 
an oxalate of the protoxide of ceriam, inodorous and tasteless, 
insoluble in water, alcohol, and ether, but freely soluble in sul- 
phuric acid, by which, as Mr. Mayer remarks, it may be distin- 
guished from the other salts of the earths. 

When I first began to use the cerium, I limited it to cases of 
advanced pregnancy, which bad resisted all the ordinary remedies, 
such as creosote, hydrocyanic acid, ice, bismuth, etc. I specify 
advanced pregnancy ; for in q^o case have I seen this trouble- 
some symptom appear before the fourth month, without yielding 
to creosote, or prussic acid, or better still, minute doses of dilute 
sulphuric acid and brandy. The following cases will illustrate 
these remarks. 

Case 1. Louisa M , »t. 82, was admitted to the obstetri- 
cal ward, 16th March, 1860, in the eighth month of her second 
pregnancy. For three months past she has had at least two or 
three spells of vomiting every day, with utter distaste for food, 
and for some time has been under treatment in this city, without 
relief. When I first saw her, on April 8d, she was ordered to re- 
main in bed, and to take one drop of creosote in emulsion every 
three hours ; no improvement following in the next two days, this 
was changed for hydrocyanic acid, and subsequently for a mix- 
ture of dilute sulphuric acid and cura<;oa. 

After the lapse of a week, her condition was unchanged, with 
the exception of increased debility. All previous treatment was 
stopped, and a pi]l of two grains of oxalate of cerium was given 
every third hour. On that day she vomited once, two hours after 
taking the first pill ; the following day she took the same amount 
before each meal, with no return of the vomiting. The cerium 
was continued one day more, and from this time until her confine- 
ment, April 22d, she enjoyed excellent health in every respect. 

Case 2. Hannah S , set. 21, primipara, was admitted to 
the same ward, April 5th, apparently in good health. But in the 
course of a week, perhaps from restriction to the plain house 
diet, she was seized, on rising from bed, with severe vomiting, 
culminating in violent retching, and returning at frequent inter- 
vals on her making the slightest exertion. For three days she 
was treated with opium, creosote, and subnitrate of bismuth, and 
kept perfectly at rest ; but as no change was perceptible by the 
19th, I resorted to the oxalate oi: cerium, giving every second 
hour a powder containing one grain of the cerium with a few 
grains of sugar. After the third dose, her vomiting ceased en- 
tirely ; but fearing a relapse, a similar powder was given before 
each meal for two days longer, with as complete success as in tbe 
former case. 



Use of the Oxalate of Cerium. 165 

Case 8. Charlotte L , let. 28, was admitted May 16tb, 

in a state of extreme nerrous prostration. She expected to be 
confined in six weeks, but during the last fonr months she had sn{- 
fered from such incessant vomiting, as to keep her in daily dread 
of an abortion. In her former pregnancies the same thing had 
occurred, once to such an extent as to induce her to labor at the 
seventh month ; and then, as now, the vomiting would begin with* 
out any assignable cause, both during the day and night. For 
many weeks, she had eaten only one meal a day, and was dis- 
gusted by the mere sight of food, ^hich was sure to bring on 
vomiting. Her great nervous debility, and the apparently un- 
controllable character of the emesis, induced me to prescribe the 
oxalate of cerium at once. She took at first two grains, and 
afterwards one grain every two hours during the day ; but the 
first dose alone seemed necessary, for from that moment the vom- 
iting never returned. The patient said it acted 'Mike a charm,'' 
and until her child was born (at full term), her health remained 
excellent, and she felt quite as well as before her pregnancy. 

Case 4. In this case, though similar to the foregoin g, the 
cerium was less happy in producing a permanent effect. When 
administered it readily arrested the vomiting for a few hours, or 
during that day; and, by keeping the patient under its influence, 
to a slight extent, the emesis was held in check, until it gradually 
passed off entirely. 

But, as I have remarked, the efficacy of oxalate of cerium ap- 
pears by no means confined to the relief of vomiting in pregnant 
women. In the vomiting tha^ often accompanies phthisis, in 
pyrosis, hysterical emesis, and the various dyspeptic conditions of 
the stomach, especially in atonic dyspepsia, I have found th^ 
effects of this remedy no less encouraging. In the following 
cases it was given to check the vomiting of phthisis. 

Case 6. C. F , set. 68, was admitted to the phthisis ward 

about the end of March, 1860. He gained slowly in strength up 
to the middle of June, when he lost his appetite, and suffered 
from constant nausea and vomiting. This was always brought on 
by a severe spell of coughing, or oy eatine a single cracker, and 
the nausea remained even when the stomacn was empty. Various 
remedies had been tried without relief, and on July 10th, he took, 
for the first time, one grain of cerium before each meal ; he vom- 
ited once that evening, and once the following day, but thence- 
forward improved rapidly, in great measure regaining his appetite ; 
and although the vomiting sometimes returned when the cerium 
was stopped, a few grains of the medicine always promptly ar- 
rested it. 

Case 6. James S , est. 31, far advanced in phthisis, with 

slight vulvular disease, had the vomiting well marked when ad« 



156 Use of the Oxalate of Cerium. 

mitted, Jaly 16th. He was extremely f eeble^ and coald eat noAing ; 
ordered Haxham's tincture and ood-liyer oil, which only sickened 
him more. He was treated then with cerium, in doses of one 
grain every two honrs ; his yomiting ceased after the Uiird dose, 
and daring the ensuing four days that he was under treatment, 
his appetite was nearly restored; but no final report could be 
made of this case, as the patient was soon after remoyed from 
the hospital by his family. 

Ckise 7. Conrad G , »t. 20, entered the medical ward with 

inherited phthisis, enfeebled from night- sweats, loss of appetite, 
and occasional yomiting, greatly increased by yiolent coughing. 
On July 18th, I ordered him a grain of oxalate of cerium an hour 
before each meal ; in two days he said he felt better than for 
many weeks ; he no longer vomited ; his appetite had returned, 
and, with his increasing strength, the night- sweats rapidly dimin- 
ished in severity, and recurred only at long intervals. 

Case 8 — was one of hysterical amenorrhoBa, characterized by 
violent convulsions, succeeded by gnawing pains in the stomach, 
with severe nausea and vomiting. I tried in vain to arrest this, 
and restore the patient's appetite by gastric sedatives, tonics, and 
nerve stimulants, but with no effect. The cerium was then pre- 
scribed in one grain doses, with which — suspecting worms in the 
alimentary canal — I combined four grains of santonine ; this was 
given in every third hour, and by evening the vomiting and gnaw- 
ing sensations in the stomach ceased, and, though they returned 
once or twice after subsequent convulsions, a few doses of the 
cerium invariably put a stop to the* symptoms, as long as the case 
remained under my charge. 

Finding the cerium so excellent in repressing vomiting, I tried 
its effects in fourteen cases of atonic dyspepsia, and uniformly 
with the same gratifying results. These cases were carefully se- 
lected, and only after an exact diagnosis was the cerium treatment 
adopted, for the benefit could not reasonably be expected where 
the dyspepsia was dependent on malignant, or other organic 
lesions. And here it is worthy of remark, that, whether in re- 
lieving the nausea, or simply restoring the appetite, the effect of 
the medicine was perceptible almost as quickly as the cases first 
quoted. The same point is emphasized in the paper of Professor 
Simpson, already referred to, and it was indeea this fact — the 
rapidity of its therapeutic action — that especially engaged my 
attention, and, after repeated experiments with this view, I was 
inclined to regard it as peculiarly characteristic of the cerium. 

In reference to the view of its therapeutic nature expressed by 
Prof. Simpson, who considers it a sedative tonic, I think it just 
to state that I endeavored to test its validity in several cases of 
acute and sub-acute gastritis, both idiopathic and supervening on 



Epidemic of Dengue or Breakbone Fever. 15T 

debsnohy or delirium tremens, but in none could I detect anj 
amelioration of the symptoms. I make this remark with no dis* 
position to impugn the opinion quoted, and only to record my ex- 
perience so far as it extends ; for, I have neither the inclination 
nor the data sufficient to build a theory upon the therapeutics of 
an agent so little known as the oxalate of cerium. 

[Jbner. Jour, of the Med. Sciences. 



jS Sketch of an Epidemic of Dengue or Breakbone Fever ^ 
as it prevailed in Wilmington^ JVbrth Carolia^ in the 
autumn qf the year I860. By Jamss H. Dickson, M.D. 

Synonyms: Dingee^ Dunga^ Dandy ^ Bouquet^ Breakbone 
Fever. — In the foregoing barbarous nomenclature, the curious 
philologist will be apt to find his ingenuity puzzled and his indus- 
try bi^ed in his attempt to trace tne origin of a word which has 
been adopted to designate a very marked and peculiar form of 
disease, without being furnished with that ^^Jilum laberynthi*^ 
which its history affords. 

It certainly furnishes a rare instance of a word finding its way 
into scientific treatises from so humble an origin ; for it carries 
with it the evidence of its negro parentage, not patent enoush to 
be discovered by any ordinary process of word-hunting, and yet 
sufficiently obvious when the enquirer has been started on the 
proper track. 

The West India negro gave it the name of Dandy fever, from 
the stiff gate which it caused its subjects to assume, when sud- 
denly seized with it, as they sometimes were, when passing along 
the street. When it appeared in Cuba, this name, in undergoing 
the Spanish pronunciation, was changed into Dunga or Dengue, 
which it still retains. 

This very unique and peculiar affection has never, so far as I 
have been able to learn, prevailed in this place before the occur- 
rence of the epidemic of which I shall now endeavor to give some 
account. 

It seems indeed to be an unfrequent visitor of any locality, 
rarely, if ever, appearing for two consecutive seasons in any 
place. 

The first notice which we have of this form of fever, is in a 
paper by Dr. Jas. Mollis, giving an account of its prevalence in 
Calcutta in the year 1821. In the latter part of 1827 it made 
its appearance in the West India islands. In the spring of 1828, 
it broHo out in New Orleans, and in the fall of the same year it 
prevailed in Charleston and Savannah. Papers descriptive of 



158 Epidemic of Dengue or Breakbone Fever. 

the disease as it prevailed in the latter cities, have been publish- 
ed by Drs. S. H. Dickson and W. R. Waring, 

It would thas seem to be a tropical or tropicoid disease, and 
yet if we can rely upon the correctness of the opinion which re- 
gards the so-called oreakbone fever, which Dr. Knsh describes as 
prevailing in the autumn of 1780, in the city of Philadelphia, as 
the disease in question, or the true Dengue, it would seem occa- 
sionally to transcend its native limits. 

Dr. Rush describes the Philadelphia epidemic as a bilious re- 
mittent fever, to which the name of breakbone fever was popularly 
applied in consequence of the severity of the pains with which it 
was attended. 

Not having at hand Dr. Rush's description of the disease, I 
am in some aoubt whether to regard that instance as one of the 
genuine Dengue, or only as a form of remittent fever, with the 
usual spinal and neuralgic pains more than usually developed. 

Such varieties of remittent fever are not very rare, but they 
must not be confounded with this very peculiar affection. 

The genuine Dengue seems to be a complex malady, combin- 
ing some or all of the characteristic features of our ordinary au- 
tumnal remittent fever, with very marked symptoms of rheuma- 
tism, together wi£h, in many cases, an eruption, closely resem- 
bling in some instances urticaria, and in others a scarlatinous 
erythema. Occasionally, the eruption assumed a miliary, and 
in some instances a rubeolous appearance. In those instances in 
which the eruption did not show itself during the progress of the 
case, the occurrence of cutaneous desquamation at the close of 
the attack left no doubt as to its true character. 

This form of fever seems to exhibit no very marked prodro- 
mata. In some rare instances it makes its approach insidiouslv, 
but for the most part it attacks with abrupt suddenness. A slight 
chilliness ordinarily ushers in a febrile paroxysm of greater or 
less severity, accompanied with headache, chiefly in the back of 
the head, and distressing pains in the loins and in the course of 
the large nerves in the lower extremities. The entire cerebro- 
spinal nervous system, as well as the peripheral extremities of 
t^e nerves, as in the great centres gave token of its pathological 
condition. 

In some instances, the chill was of very marked intensity, and 
the febrile reaction in such cases was apt to be of corresponding 
severity. Restlessness and a sense of great debility are apt to 
be prominent attendant symptoms. 

The pains in the limbs and joints, described as rheumatic, 
though for the most part uniform in their resemblance to that dis- 
ease, were occasionally seemingly capricious in their character, 
attacking the smaller joints, and now and then the stomach and 



JS^idetnic qf Dengue or Breakbone Fever. 159 

bowels, giyiog the ease in these features no slight resemblance to 
gout. 

In our epidemic, an attack of Dengue was by no means uni- 
form in its duration or its intensity. Indeed, it ran through 
every gradation from the mild ephemeron, scarcely requiring 
any treatment, to a grave form of fever of ten or twelve days' 
duration. A striking feature in most cases of any severity, was 
nausea and precordial distress. In some instances, the gastric 
irritability was a very prominent symptom, and one which, by its 
obstinate persistence, seriously embarrassed the treatment. 

It is usual to ascribe the occurrence of this disease to epidemic 
influence, and in the present state of our knowledge it is perhaps 
impossible to assign it a more specific origin. This epidemic in- 
fluence or occult cause would seem to have engrafted itself (in 
our epidemics) on the ordinary morbific cause of autumnal remit- 
tent fever, for the cases evidently partook largely of that charac- 
ter, though in some of its features it was almost proteon ; for, 
we might, with strict propriety, characterize one case as rheumatic, 
another as gout, another as scarlatinous, &c. It seemed to be 
no respecter of age or sex, all classes being equally liable to be 
attacked by it. 

A very small fatality seems to be a notable diaracteristic of the 
Dengue ; for thoueh many suffered severely and some were seri- 
ously threatened, I believe no fatal case occurred. 

Some of the writers who have given us a description of this 
form of fever, think that they have discovered in it a resemblance 
to the yellow fever, in the circumstance of its having but one 
paroxysm, with a long and delusive intermission, followed in the 
one case by a return of a fatal exacerbation, and in the other by 
a febrile paroxysm, which undergoes solution by the occurrence 
of a cutaneous exanthem. I am constrained, however, to regard 
this as a forced and painful analogy. At any rate, such a form 
of the disease was not observed in the epidemic which I am en- 
deavoring to sketch in this paper. Instead of the peculiar parox- 
ysmal form of yellow fever, this epidemic assumed the garb of 
biiious, remittent J with daily exacerbations and remissions. Its 
want of fatality, too, is a feature which separates it widely from 
yellow fever, and the extinction by the occurrence of frost is 
equally characteristic of bilious ana yellow fever. 

The most probable conclusion from all our observations and 
comparisons, would seem to be, that the Dengue is protean in its 
phases, and ^^sui generis^^ in its nature. 

Sequelx. — A very striking and somewhat protracted debility 
was not an unfrequent sequel of the disease. In some instances, 
among children, a paralysis in the lower extremities occurred, 
and was of considerable duration ; but I believe this serious sequel 
of the malady has not been permanent in any instance. Dr. W. 



160 Uva Urai in Labor. 

G. Thomas informs me that several cases of this kind fell under 
his observation, all which have recovered or are convalescing. 
The occurrence of such a sequel of the disease as this, indicates 
that the nervous centres b^r very largely the onus of the disease, 
and exhibits an intensity oc action of the morbific cause far ex- 
ceoding the action of the cause of most other forms of fever upon 
the spinal axis. When paralysis occurs as a result of convulsive 
remittent fever in children, it almost invariably assumes the form 
of hemiplegia, and is generally of very transient duration. 

Treatment. — Many of the milder cases were treated by the 
exhibition of a mild aperient, and a sudorofic anodyne. The se- 
verer cases seemed to call for the treatment which has been found 
needful and appropriate in our ordinary form of bilious fever. A 
mercurial cathartic (generally a pill of mass, hydrarg.) followed 
by a saline aperient, or a dose of calcined magnesia, was admin- 
istered at the invasion of the attack. This was followed by the 
use of sulph. quinine, with or without the addition of an opiate as 
circumstances seemed to indicate. 

In the large majority of cases, the opiate was found indispen- 
sable ; for in by far the larger proportion of the cases, the spinal 
and articular pains were decidedly pronounced and called loudly 
for their administration. Diffusible stimuli were found useful in 
some cases in which unusual debility and prostration occurred, 
but the great mass of the cases were conducted to a satisfactory 
convalescence by the use of mild tonics. — JV*. C. Med. Jour. 



Uva Ursi in certain Cases of extremely Slow Labor. 

Dr. A. Gauchet has proposed and employed the uva ursi in 
certain cases of tedious labors which are usually treated by ergot 
of rye. He calls attention to the dangerous consequences which 
sometimes follow the employment of the latter drug, and thinks that 
the uva ursi will be found equally useful, and at the same time less 
violent in its operation. He relates a case of tedious labor in which 
was administered uva ursij four drachms of the leaves being infu- 
sed in a pint of water, a cupful of the infusion being given every 
half hour. The effect of the medicine was to increase the force and 
frequency of the uterine contractions, and the labor terminated a 
few hours after the first dose had been given. Dr. Gauchet gives 
another case of imperfect and irregular contraction of the uterus 
after labor, in which case the uva ursi seems to have had the 
effect of causing regular contraction of the organ, and the patient 
recovered without any bad symptom. Dr. Gauchet has also tried 
this remedy in nine cases of tedious labor, all of which termina- 
ted successfully, and he therefore believes that this new plan de- 
serves the attention of practitioners. — Brit. Sc For. Med. Chir. 
RevieWy—from Bull. Gen. de Therap. — Savannah Medical 
Journal. 



5 



Treaimeni of Mania a Potu. 161 



DigUcUiB in the Treatment of Mania a Potu. By Q. 0. 
Catlbtt, M.D. 

The experience of the physicians of this city (St. Joseph, Mo.,) 
80 far as my knowledge extends in the treatment of mania a potu, 
ha8 been very unsatisfactory. Most of the attacks, assuming a 
remarkable acute form, with great violence of delirium, furious 
mania, and persistent mental aberrations, have generally resisted 
the opium and stimulating as well as all of the former established 
methods of treatment for this unfortunate class of sufferers. 

So great has been the mortality from this disease during the 
last four or five years, notwithstanding we have attempted to 
discriminate between the chronic and the acute forms, that we 
have become apprehensive that we have not been treating alcoho- 
lic poison. Indeed so general has become the impression that 
the various alcoholic drinks, generally used, contain a foreign poi- 
son, that those who are in the habit of becoming intoxicated are 
significantly said to have taken passage on the strychnine line 
for an unknown destination. While the symptoms of the numer- 
ous cases that have come under my observation do not in the 
slightest resemble those from the poison of strychnia, yet the 
great apparent difference in the character of the symptoms as 
well as in the result of the disease — produced by excessive use of 
alcohol — at the present and former periods, that it would very 
naturally create apprehension and strike terror to the spiritually 
infatuated. 

There have been a few persons, who, by a prolonged debauch, 
have induced inflammation of the mucous membrane of the stomach, 
or at least such a degree of irritability that a continuation of in- 
dalgence was impossible, as nothing introduced into it would be 
retained ; soon therefore, from the withdrawal of the stimalus, 
delirium tremens would supervene, characterized by intense hal- 
lucinations, great tremulousness, incapacity to sleep, irritabili^ 
of stomach, tender epigastrium, and deficiency of the secretions. 
Counter irritation to the epigastrium, a mercurial cathartic, stim- 
ulants judiciously administered (I prefer tinct. serpentaria; and 
tinct. valerian, equal proportions), and morphia pro re nata^ 
will generally in my hands relieve such cases. But that form of 
this disease that is produced by the constant daily use of alcohol 
long continued, poisoning the blood and resulting in acute mania, 
is the fatal form, or properly mania a potu. £l relation to this 
form of the disease Prof. Stone of New Orleans says : 

<< Brain fever and apoplexy are terms often kindly substituted 
as being more respectaole ; but names do not alter facts. Mania 
a potu usually occurs with the robust who habitually use alco- 
holic stimulants, but not to any great excess, except upon occa- 

VOL. XIX — ^11 



162 Treatment qf Mania a Potu. 

sions ; and when they are carried to a certain extent, a necessity 
for their continuance is created, and their excessive use can not, 
or will not, be resisted until the stomach gives way and finally 
rejects them. During this process, the mucous membrane be- 
comes engorged, the digestion, and finally the appetite, entirely 
fail, and the patient is sustained for some days after by stimu- 
lants alone, until furious delirium sets in. 

''This madness is not due to the stoppage of an accustomed 
stimulant, for it often sets in while the subject is in the full use 
of it, but it is plainly due to alcoholic poison and the absence of 
proper nutritive matter in the blood. I think I may add another 
cause which has often something to do in causing the delirium, 
and certainly much to do in causing death, under some modes of 
treatment, and that is suppressed excretions. So long as the 
stomach is intact, and the appetite and digestion good, an im- 
mense quantity of stimulant may be disposed of without serious 
immediate consequences ; but when the organs, finally, from con- 
stant excitation, become engorged, nutrition ceases, and the alco- 
hol is retained more in the blood, instead of being cirried off by 
excretions, and a wild delirium soon follows. 

''It is plain, under these circumstances, that the indications 
are to establish the excretions, disgorge the system of the alco- 
holic poison, and to introduce proper nutriment. The first two are 
accomplished by one and the same means. The stomach is gen- 
erally irritable ; at least, there is frequent vomiting ; but it is 
owing to the accumulation in the stomach of morbid secretion, 
rather than from inflammation or even irritation ; for calomel in 
small doses, frequently repeated, arrests it with great certainty. 
If the subject is governable, and will take medicine willingly, 
calomel should be given in two or three grain doses every hour, 
or oftener if the case is urgent, until fifteen or twenty grains are 
given ; if medicine has to be given by force, it is best to give a 
full dose at once ; and this is the better, for in the worst cases 
the stomach is not nauseated, and the sedative effect of a large 
dose of calomel calms the nervous excitement, and at the same 
time produces the appropriate effect upon the excretory organs 
and mucous coat of the stomach and bowels. It requires some 
hours for this effect to be produced, and it is improper to give 
any thing to promote its action upon the bowels under ten or 
twelve hours, and I think even a longer time would be better, if 
the case is not urgent. Small and frequently repeated doses of 
saline medicine are the best, after the calomel ^sulphate of mag- 
nesia is best), which promotes the excretions, dissorges the stom- 
ach and bowels, and clears the system of its alconolic poison, to 
its great relief. An active cathartic may afford some relief, but 
the system is not so well disgorged by it ; more or less serum 
from the blood is carried off, causing weakness ; while, in the 



Treatment of Mania a Poiu. 168 

other process, by giving time for the action of the calomel^ and 
then promoting it by gentle but continued means, the organs ex- 
ercise a selection in excreting, and thereby a large amount of 
effete matter is discharged, and the patient reels the stronger for 
it, being freed from an incubus that was weighing it down, and 
producing apparent exhaustion. After this process, we should 
lose no time in introducing nutriment, and for this purpose milk 
is almost universally applicable ; and, as the mucous membrane 
of the stomach seems to be denuded of its epithelium, the addi* 
tion of lime water renders it particularly grateful and soothing. 
Patients in this condition generally loathe animal substances, but 
milk is almost always grateful to the taste, and is particularly 
appropriate, for it furnishes the most innocent solid for the bow- 
els, that have been long deprived of their wholesome stimulus. 
If it should happen that a patient could not take milk, well-boiled 
commeal gruel is the next best diet most likely to be relished ; 
and, for something more substantial, strong well- seasoned broth, 
frozen, will be the most likely to agree. 

^^In all acate cases, alcoholic stimulants should be withheld, 
for they act like poison, and will often bring back delirium. 
Should stimulants be thought necessary, (and it is not often 
really necessary,) the carbonate of ammonia, or the aromatic 
spirits of ammonia are preferable ; or, it maybe proper, in some 
cases, to allow malt liquor. Opium, in all forms, should be 
prohibited, until the system is relieved of its alcohol, and even 
then I find it can generally be omitted ; and when it can be, the 
patient recovers sooner and better. The patient is not expected 
to sleep well ; but if the blood is renewed by its appropriate nutri- 
ment, natural sleep will soon follow. 

<^ Occasionally, when previous to the debauch which imme- 
diately caused the mania, a free use of stimulants had been in<» 
dulged in for some time, we have an exalted state of the nervous 
system, attended with hallucinations and sleeplessness, which re- 
quire special attention. Potent stimulants operate badly, and 
opium alone does not operate well, though in large doses sleep 
may be forced, though not without some risk, in some cases, to 
the brain ; but equal parts of morphia and tart, antimony, given 
in small and repeated doses, will soon calm the nervous system 
and induce sleep without injury either to the brain or stomach. 

There is nothing that cools off the heated imagination in these 
cases like nauseating doses of tart, antimony, and opium in some 
form may be added, if it is thought necessary •* The too general 
opinion that sleep is the all -important thing in this disease has 
led to fatal errors in treatment. Opium, given freely, as it often 
and very generally is, while the blood is charged with alcohoL 
produces a very unfavorable effect upon the nervous system, and 



164 Treatment of Mania a Potu. 

tends to check the excretions, which are already diminished, and 
the patient, without being narcotized, often goes into a stapid 
state resembling the effects of uremic poson ; and if about one 
half (about the usual proportion), bj the vigor of their consti- 
tutions, weather it, in spite of all the poisons imposed upon them, 
they recover slowly, ana their organs are left in a bad condition." 

We make this lengthy extract from Prof. Stone's communica- 
tion on this subject, because he makes the important distinction 
between delirium tremens and mania a potu^ and in his usual 
clear manner points out the rational treatment in the two forms 
of the affection : these views, we think, should be more thoroughly 
impressed upon the profession ; notwithstanding, we are satisfied 
that the difference in the two forms of alcoholic poison is clear ; 
the treatment of Dr. Stone is the rational treatment. Yet the 
mania a potu that has occurred in this city for the last few 
years, has been remarkably fatal, and all methods of treatment 
very unsatisfactory. 

Therefore, 1 determined to try the tinct. digitalis in large doses — 
recently, two cases presented an opportunity. The first a man, 
the second a woman. A description and treatment of one case 

will describe both in all essential particulars. Mr. , after 

a debauch of several weeks, and while yet stimulated to as great 
a degree as all the varieties of alcoholic drinks could produce ; 
in attempting to light a segar, fell upon the floor in the most 
frightful convulsions, raving, and foaming at the mouth, and 
mutilating his lips, tongue, hands, and arms with his teeth. In 
half an hour after this convulsion he was furiously delirious, 
recognizing no one, muttering his imaginary fears, and now and 
then making fearful struggles to escape from his bed ; his face 
almost livid; eyes deeply injected, and eyelids greatly swollen ; 
pulse one hundred and sixty, weak and thread-like. 

In the interval of the convulsions, and before my arrival, half 
a grain of morphia had been administered to him. I immediately 
administered five grains of ipecac, and two grains of tart, emetic ; 
repeated it every fifteen or twenty minutes, until he had ejected 
every thing from his stomach. This occupied several hours when 
his symptoms were not in the slightest improved. I then deter- 
mined to watch the action of the digitalis, and commenced by 
administering a large teaspoonful every half hour. The first dose 
improved his pulse — it diminished in frequency and increased in 
volume. The second dose lessened his ravings and made a more 
palpable improvement in his pulse. The third dose was increased 
one half, when all of his symptoms in one hour were manifestly 
improving. I then increased the dose and lengthened the time 
of administration, in about seven hours from the taking of the 
first dose ; his pulse was now full slow and regular ; his delirium 
had entirely vanished and he was sleeping, though interruptedly, 



On Epidemic Dj/seniery* 16^ 

now and then distarbed by his hallacinations. I then continued 
the tinct. digitalis in smaller doses, and gave a mercurial cathar- 
tic ; his sleep became sound and tranquil ; he awoke in about six 
hours, sane in mind, and almost well in body. The only remain* 
ing vestige of disease was extreme nervousness. I then prescribed 
tinct. valerian and compound tinct. of cinchona, in equal quan« 
tities. 

The second case was almost as severe as the first and was 
treated in like manner and resulted as favorably. If digitalis 
acts by sedation, will not veratria be a more efScient remedy in 
mania a potu f 

[S/. Joseph (^Mo.) Med, Jour. 



On Epidemic Dysentery. By Prof. Troussbau. 

The year 1859 was remarkable in France for the prevalence of 
a terrible epidemic of dysentery. While in former years, the af- 
fection has been observed only in circumscribed localities, it pre- 
vailed during the past year almost universally. Paris, too, wnick 
has perhaps been exempted from epidemic dysentery for a een 
tury, has had, on the present occasion, to pay a large tribute. 
Commencing towards the end of July, the epidemic attained its 
maximum in September, undergoing a notable diminution in in- 
tensity towards the end of October. Of all epidemic diseases, 
dysentery is the most murderous — typhoid fever, cholera, diphthe- 
ria, variole, and scarlatina being but as child's play compared 
with it. These affections prevail only accidentally, while dysen- 
tery decimates whole populations, returning at certain fixed 
epochs, as every three years, for example. Dosgenettes declared 
that it killed more soldiers than the enemy's cannon did between 
the years 1172 and 1815. The etiological circumstances of the 
invasion of an epidemic may be quite inappreciable. Thus, at 
Tours, there are two barracks placed in identical hygienic condi* 
tions, and yet, during thirty years, it has always been the cavalry 
barracks in which dysentery has prevailed epidemically. The re- 
puted effects of the excessive use of fruits in generating the dis- 
ease is very doubtful, seeing that it sometimes rages when fruits are 
very scarce, as in 1859, while it may not be met with when they 
were in excessive abundance, as in 1858. 

Passing by M. Trousseau's description of the disease, we come 
to his account of the treatment. His right to speak with some 
authority upon this point, is derived from the fact of his having 
witnessed four epidemics of the disease at Tours, Versailles, and 
Paris, during which the victims were either young and vigorous 
soldiers, aged men and women, or young children. Moreover, a« 



166 On Epidemic Dysentery. 

reporter on Epidemics to the Academy, he has to peruse the ac- 
counts of the various epidemics which appear throughout France. 
Some thirty or forty years since the traditions of the former age 
were abandoned, Broussais sweeping away the whole of the em- 
pirical modes of treatment in favor of his doctrines. In fact, 
with an inflammation so violent in view, it was then difficult not 
to give in to them ; and the antiphlogistic treatment was put freely 
into force, and when unsuccessful, this was believed to be because 
it had not been carried far enough. In 1823 or 1824, however, 
M. Bietonneau, imbued with the medical doctrines of Stahl and 
Sydenham, set on foot a re-action against the doctrines of Brous- 
sais, by resorting to a substitutive mode of treatment. He gave 
an ounce of the sulphate of soda internally, and administered the 
same dose in a very copious enema, once or twice a day, continu- 
ing the practice as long as the stools remain bloody. As soon as 
they became bilious and serous, the sulphate was only given once 
a day, then every other day, and afterwards at still rarer inter- 
vals. In 1828 or 1829, M. Trousseau published an account of 
an , epidemic treated with success in this manner. In 1842, an 
epidemic occurring in the garrison at Versailles was similarly 
treated, but with less marked success however, at all events, the 
military surgeons in attendance — almost all pupils of Broussais — 
agreed that the sulphate of soda was preferable to blood-letting. 
Unanimity in favor of neutral salts, or one kind or another, has 
nUo nearly prevailed in the reports addressed to the Academy 
from all parts of France. Frequent failures have undoubtedly 
occurred, but, in general, when advice is sought early, consider- 
able and extremely rapid success is the result. Induced by the 
success of the calomel treatment employed by the English at 
Gibraltar, M. Trousseau has several times put it iuto force, and 
frequently with good effect in severe cases of dysentery, occur- 
ring, however, sporadically. He still resorts to it when the 
weather is very hot, but in cold and wet seasons he has found 
salivation and other ill consequences result from its employment. 
In children, too, who can only be got to take the sulphate of soda 
with the greatest difficulty, he prefers giving calomel. Ipecacu- 
anha, which was so much in vogue during the last century, is now 
seldom employed. Opium is one of the sovereign resources of 
the materia medicay and is perhaps the pharmaceutical substance 
with which most harm may be effcct'Cd. It is in incessant use, 
and is strangely abused, being, in M. Pidoux's happy phrase, the 
** knout of the therapeutist." With it every patient who com- 
plains or suffers is fustigated. In vain may you try the rational 
))rocedures consecrated by usage, and in vain do you appeal to 
your intelligence and your experience — all goes for nothing — pain 
IS present, and the indication which dominates all others is to 
assuage such pain, for which opium must be prescribed. With 



Finger JVbii Signs. 167 

such logic as this we make but a bad basiness of it, or may en- 
gage in a- verj perilous work. A distribution of opiates with 
easy compliance is the mark of an impatient and ignorant practi- 
tioner. It is a very convenient procedare, and one to which 
every capacity is competent, which consists in '^drying up the in- 
testinal canal'' by laudanum in a case of diarrhoea, and in roughly 
imposing silence upon the symptom pain in a case of dysentery 
attended with horrible tormina. ^^I do not pretend to say that, 
after having put into force the evacuant treatment, that we must 
never, when the patient is suffering cruelly, temper his pains by 
a few drops of laudanum, but I entirely object to the practitioner 
at once drying up the intestinal canal f for this is the aim) in a 
case of diarrhoea or dysentery. Let him not meddle with opium 
except with cautious reserve, or ho will be the cause of the ty- 
phoid symptoms, which will soon make their appearance.^' After 
passing in review the various other means of treatment, to which 
ne does not seem to attach much importance, M. Trousseau adds, 
that all these means will be of little avail if not adopted prior to 
the occurrence of important pathological changes. Otherwise, 
every effort will be paralyzed, and no means will avail against 
the horrible ravages of an epidemic. In conclusion, above all 
things, let the condition of the diet be attended to, for this is of 
vital consequence. Insist that two, three, or even four quantities 
of soup Qpotage) be taken daily, and prescribe feculent drinks, 
as barley and rice waters. In all the comparative trials which 
have been made of treating dysentery by rigorous abstinence, or 
by allowing aliment in wise moderation, advantage has attended 
the latter procedure. — Gaz. ties H6p. — Maryland Si* Virginia 
Med. Jour. 



Finger 'MiU Signs. — ^In jjoing round the wards of the Cha- 
rity with M. Beau, a novice will be not a little puzzled at seeing 
him scrutinize closely the finger-nails of each newly admitted 
patient, telling him occasionally, after a few moments' examina- 
tion of his cuticular appendage: '^ My friend, you had a bad ill- 
ness so many months aeo, a very severe illness that pulled you 
down a good deal ; and then you had a relapse," and so on. 
This sort of inverted palmistry puzzled me sorely at first, and I 
confess that even the explanation, when given, left me very scep- 
tical as to the infallibility of this retrospective fortune telling. 
Nevertheless, although I do not believe in Hume, the spirit- 
medium, any more than in Hahneman and his microdosic follow- 
ers, I do believe in this sign of the past as indicated by the 
nails. If von look at the fingers of a roan who had typhus fever 
three months ago, let us say, you will find on the nails, towards 



168 The Hot Springs qf Arkansas. 

their centre (at that interval of time,) a transverse farrow, deep 
and well-marked, coinciding with the moment when the check in 
their nutrition occurred — the depth of the depression being in 
proportion to the severity of the illness, its breadth with the dura- 
tion ; and the several consecutive relapses (if such occurred) be- 
ing each notched on the ungual appendices as on so many tally* 
sticks. Few men know that they have the past history of their 
own cases so thoroughly at their fingers' end. 

[London Lancet. — Savannah Med. Jour. 



THB HOT SPRINGS OF ARKANSAS. 

Of the Hot Springs, there are some fifty-four distinctly recog- 
nizable, besides a considerable number in the bed of the creek. 
With one exception, their temperature ranges from 120*^ to 148^ 
of Fah., and their composition is nearly the same. The excep- 
tion is a warm spring (temperature 100^^ discovered a year ago 
on the bank of the creek beneath the otners. It has a strong 
odor and taste of sulphur, and is believed to have considerable 
virtues. 

The quantity of water discharged by the various hot springs is 
estimated at 350 gallons per minute (one spring affording sixty 
gallons), or, say about 500,000 gallons per diem. 

The analysis of the water is as follows (by Prof. Owen, State 
Geologist, Arkansas) : 

1} (one and a half) gallons of water contain — 
Of silica, with sulphate of lime 
Carb. of lime, 1.68, and bi-carb. of lime • 
Carbonate of magnesia . 
Bi-carb. of magnesia 
Sulph. of lime, dissolved in water 
Chloride of potassium 
Chloride of sodium . 
0)ride of iron, with a little alumina 
Dry powder (in solution) 

The average attendance of visitors this spring and summer has 
been about four hundred, chiefly of persons afflicted with rheuma- 
tism, neuralgia, paralysis, dyspepsia, mercurial affections and 
syphilis. Rheumatism is the most frequent of these. 

The baths are taken according to the custom of the place, with- 
out immediate medical supervision. Small wooden bath-houses 
are fitted over the creek, and close to the precipitous edge of the 
hill. Wooden reservoirs retain the water, which they receive 



1.04 grains. 


2.04 




0.326 




0.05 




0.85 




0.05 




2.18 




0.188 




1.16 





Oouiy Concretions in the Ear. 169 

through wooden troughs, ttBtil it is sufficiently cooled to be borne : 
it is then dropped in a stream of about an inch in diameter, from 
a height of nine or ten feet, upon the affected part, or the body 
generally (the time, according to the patient's power of endu- 
rance), and is received into a large wooden tub used for the 
plunge bath. A small chamber adjoining receives the steam from 
the constant flow of water, through wooden strips on which he 
stands, and drinking copious draughts of *^hot and hot" in the 
meanwhile ; the patient endures the vapor for five or ten minutes 
without any apparatus for breathing of fresh air, an occasional 
protrusion of the nose at the door being necessary ; after which, 
more drinking of *'hot and hot," and to bed, to sweat profusely 
under blankets from half an hour to two. This, once or twice a 
day, and the frequent drinking fresh hot during the day, other 
medicines being laid aside. This is what custom prescribes. 

A. J. Wright, Esq. 
[•^V*. 0. Med. Sf Surg. Jour. — Boston Med. Jour. 



aOUTY CONCRETIONS IN THE BAR. 

Concretions, occupying the lobe of the ear, within the helix, in 
the shape of small round prominences, under the skin, have often 
been observed in gouty nersons, i. e., in subjects presenting man- 
ifestations of the lithic aiathesis. Left to themselves, these con- 
cretions are sometimes spontaneously eliminated without the in- 
terposition oE any inflammatory action, and leave a slight scar 
behind. 

This is not a new disease. English practitioners, who have 
more frequent opportunities than ourselves of studying gout, have 
already observed them. Garrod asserts that they are to be met 
wish in half the cases, and even that their appearance sometimes 
precedes the other manifestations of the morbid diathesis. This 
would therefore be a very valuable element in the diagnosis of in- 
cipient gouty affections. Mr. Charcot has observed but six indi- 
viduals afi'ected with gout, in consequence of the rarity of thifl 
disease fp hospitals ; of these six patients, three presented the 
concretions wo have just noticed. Extracted by means oE a small 
incision, they displayed the aspect of a plaster-like matter, con- 
stituted by hard crystals. If they are analyzed, their chemical 
composition is found to be that of articular tophus ; the addition 
of acetic acid causes the deposition of uric acia, in very apparent 
crystals. 

IMd. 8r Fa. Med.^Jour. 



170 Treaimeni of Dipkthtria. 



THB LOOAL TBBATMEKT OF DIPHTHSBIA. 

The Union Medicate has recently published two letters from 
MM. Loiseau and Tronsseaa on the use of tannin and alum 
locally in the treatment of pharyngo- laryngeal diphtheria. 

M. LoiseaUy considering the false membraneB, in all cases, to 
be bat conaeqaences of diphtheria, and, with the exception of 
cronp, rather nsefnl than injurious, provided their putrefaction 
be prevented, again lays stress upon the beneficial action of 
styptics, and especially tannin ; these seem to convert the morbid 
secretions into an imputrescible epidermis, which affords protec- 
tion to the denuded surfaces and promotes their cicatrization. M. 
Loiseau performs insufflation of alum five or six times a day, and 
of pure tannin, equally often ; he states that a cure may thus be 
effected in three or four days, on the same principle which M. 
Trousseau adopted in his practice in 1828. A quotation from 
an article published on the subject in 1883, by M. Trousseau in 
the Dictionnaire Medical, has elicited from the learned professor 
a reply which we reproduce, as it explains the changes his views 
have undergone on the efficacy of the medical treatment of diph- 
theria, and more especially of croup. 

**It is perfectly true," says M. Trousseau, at the date of Sep- 
tember 20th, ^'uiat in the epidemics of diphtheria, which from 
1818 to 1828 prevailed in the departments of Indre-et- Loire, 
Loir-et-Cher, and Loiret, the disease of the fauces readily yielded 
to frequent insufflation of alum, and to cauterization with muri- 
atic add or nitrate of silver. It is equally true that, when the 
complaint was met in its early stages, four or five days were suffi- 
cient to effect a cure, excepting, of course, when diphtheria had 
invaded the larynx. 

« For ten years past, however, diphtheria has acquired in Paris 
and in the provinces a degree of gravity and of malignancy which 
it did not, by any means, possess thirty years ago ; and 1 declare 
that it is now a long time since I have had the good fortune to 
see genuine pharyngeal diphtheria vield to treatment in four or 
five days. Common pseudo-memoranous angina, or herpes of 
the fauces, mav be cured in twenty- four or forty-eight hours, 
but not real diphtheria, such as we too frequently meet with. 

<^I resort to the same means as M. Loiseau and perform in- 
sufflation into the throat every two hours, and even every hour, if 
necessary, alternating the use of equal parts of sugar and alum 
or tannin. From time to time, I brush rather roughly the uvula 
and tonsils, before resorting to insufflation, in order that the 
medicinal agents may come into immediate contact with the mu- 
cous surface, and I consider myself very fortunate when, after 
ten days' treatment, all trace of false membranes has disap- 
peared. 



Treatment of Traumaiic Tetanus. ITl 

««In five adults whom, iritbin the last few months, I attended 
with my friends, Drs. Bernard, Patouillet and Blondeaa, the dis- 
ease lasted nine days in one case, and more than a fortnight in 
the others, and I repeat that it would have been utterly impossible 
to use with more persevering energy the remedies extolled by M. 
Loiseau, which I consider most useful, namely, alum and tannin. 

*' Appealing to the testimony of my learned colleagues of the 
Hospital for Infancy, MM. Blache, Bouvier, Roger, S^e, and 
of Dr. Barthez, I find their statements are perfectly similar to 
mine, and that they agree with me in thinking that the singularly 
rapid, extraordinary and numerous cures eflfected by M. Loiseau 
may perhaps be accounted for by his not having allowed himself 
sufficient time to establish an incontrovertible diagnosis. 

^^ It is difficult at first, and especially in children, to distinguish 
genuine diphtheria from pharyngeal herpes ; and although in 
doubt, I prescribe the local application of alum and tannin, I do 
not flatter myself that I have efi*ected a cure of tonsillary diph- 
theria when, after twenty-four hours, I cease to detect in the 
throat any pellicular concretions." 

We are happy to be confirmed by so competent an authority, 
in the remarks we have offered above on the importance of diag- 
nosis in the appreciation of the various remedies recommended 
for a disease the gravity of which, far from subsiding, seems 
rather on the increase, especially when observed in an epidemic 
form. — Maryland 4* Virginia Med. Jour. 



Case of Traumaiic Tetanus treated with success by Injections 
of Sulphate ofMropia. — ( Gazette MSdicale de Lyon.) 

Dr. Dupuy has recorded a case of traumatic tetanus in which 
the subcutaneous injection of sulphate of atropia was employed 
with success. The patient was a young man who had suffered a 
comminuted fracture of the index finger, followed by tetanus. 
Extract of belladonna was administered without any appreciable 
effect, and the tincture was equally unsuccessful. The surgeons 
in attendance removed the splinters of bone under the use of 
anaesthetics, but on awaking the patient was more agitated than 
before ; the jaws could scarcely be opened, and the trunk rested 
only upon the occiput and pelvis. The dose of extract of bella- 
donna ^as doubled, but without apparent effect. As the disease 
was still advancing, and the means nitherto employed were unsuc- 
cessful, it was determined to inject with sulphate of atro'i 
Twenty-fivcf drops of a solution were injected by means of 
svringe into the subcutaneous tissue of the lumbar region. At 
the end of a quarter of an hour there were symptoms of poisoning 



172 ^n Extraordinary Case. 

by belladonna, the agitation of the patient being so great that 
two persons conld scarcely restrain him. This state continued 
for some time, after which he fell asleep for three hours. The 
stiffness of the lower limb then diminished and the patient could 
bend his knees, but the opisthotonos and trismus remained. 
Another injection was performed in the lumbar region, and was 
also followed by symptoms of poisoning. The patient after- 
wards slept for five hours, and from this time the symptoms grad- 
ually diminished; the wound being dressed with a pommade 
containing belladonna. — Md. Sr Va, Med, Jour. 



AN BXTRAORDINARY OASB. 

We extract the following from a Parisian letter to the ^'New 
York World." The case has been referred to by several of the 
recent medical journals, but in none have we seen so full an ac* 
count as the one below. — [Eds. 

A fact of considerable interest to medical men has just been 
reported to the academy of medicine by the surgeon of the Hos- 
pital St. Eloi, at Montpelier. Professor Baisson, the surgeon in 
Question, states that on the Ist of August, 1858, a man about 
fty years of age was brought to the hospital by persons who 
were not able to give any precise information with regard to him, 
and the patient himself, being interrogated, gave incoherent re- 
sponses. It was found, however, that he exhibited none of the 
signs of paralysis, that he had no fever, or any symptom of an 
acute disease. Upon examining his eyes, it was ascertained that 
he was deprived of sight by tho existence of a double cataract. 
The patient could himself give no information as to the time 
which he had been afflicted, and in answer to all questions con- 
tinued to give utterly unsatisfactory and incoherent replies. The 
person who had brought him to the hospital, informed the sur- 
geon that he was in the habit of talking this way, of being con- 
tinually murmuring to himself, and that he appeared to take no 
cognizance of what was passing around him. His appearance, 
and the facts which he was able to gather, satisfied M . Buisson 
that the unfortunate man was, at the same time, suffering under 
blindness and dementia. Fifteen days his symptoms were closely 
observed, and he was, during this time, placed upon a severe 
regimen, for the purpose of removing the effects of any recent 
morbid influence. No marked change, however, ensued; he still 
exhibited the same degree of imbecility, and when spoken to in re- 
lation to an operation for his cataract, he exhibited no sign of 
satisfaction or of hope. In short, he continued to exhibit all the 
usual symptoms of dementia, and the surgeons satisfied them- 



An Exiraordinary Case. • 173 

selves entirely that this was not the result of the abuse of alco- 
holic drinks, or that it followed any sudden shock of the nervous 
system. The patient had been a daily laborer, working upon a 
farm, and had continued his labor up to the time when the total 
loss of sight prevented him from working longer. 

M. Bnisson endeavored to ascertain whether the enfeeblement 
of the intellectual faculties in the case of this patient had com* 
menced before or simultaneously with his loss ot sight. It is a 
fact well known to medical men that blindness often follows cere- 
bral affections, but in these cases it is of a purely nervous nature ; 
it is amaurosis, that is to say, a paralysis of the retina, result- 
ing from the general paralysis. Bat this was a case of an en- 
tirely different nature— the blindness here having a well defined 
anatomical cause. The patient was afflicted ^th cataract, which 
is a physical alteration of the crystaline lens, an affection which 
does not in the slightest degree depend upon the condition of the 
brun. With all his exertions, however, M. Buisson was not able 
to determine whether the blindness had preceded or followed the 
mental disease. 

Such was the condition of this patient when M. Buisson deter- 
mined to restore his sight by performing the usual operation for 
cataract^ which was done upon both eyes on the 16th of August 
last. He was placed under the influence of chloroform, and was. 
in such a profound condition of ansssihesia that the first stroke 
of light upon the eye did not even cause a contraction of the 
pupil. The usual dressings were placed upon the eyes, so that 
the light should be excluaed, and the patient being placed in a 
straight-jacket, in order to prevent him from touching his eyes, 
was carried to his bed without exhibiting the slightest knowledge 
of what had passed ; and daring the ten days that he was con- 
fined in a dark chamber, he gave no sign of intelligence or of any 
consciousness that he had submitted to any operation whatever. 
On the tenth day, the bandages were carefully removed and the 
light gradaally permitted to break upon his eyes. For the first 
time since his admission to the hospital, he gave a sign of intelli- 
gence. A smile-^illy, but joyous — spreading over his whole 
face, and he cried, ^'I see! I see!" These were the first reason- 
able words to which he had given utterance since he had been in 
the hospital. Day after day, gradually, he was allowed to have 
more light, and day by day, as the experiments confirmed the 
perfect success of the operation for the cataract, they also proved 
what had not been dreamed of — the return of reason. As his 
sight became stronger, the patient became more docile. Less 
contrary and less indifferent to questions put to him, he began to 
make ready and reasonable replies. Every day marked the re- 
turn of intelligence. He recognized obiects about him, and utter- 
ed their names with a childish joy, and reached out his hands to 



174 On Hemorrhage from the Bowel. 

seize them. This new ocular edacation, however, was not long 
reqaired. His memory returned to him with a daily appreciable 
strength, and his intellectual faculties began to ezhioit them- 
selves. He demanded an augmentation of his ration, desired to 
get up, and already began to talk of leaving the hospital. Still, 
as his sight erew stronger, his words grew plainer and more con- 
secutive, ana his ideas clearer and without incoherence, and the 
memory of events which occurred prior to his loss of sight began 
to break upon him. It was impossible, however, to ascertain 
with any degree of certainty when his mental powers began to 
fail, or were lost, and all that could be learned of hb loss of 
sight was, that it commenced about three years ago. A month and 
a half after the entrance of this man, blind and demented, into 
the hospital, he was at work again, with his vision and his mind 
restorea. The man was completely metamorphosed, not only 
in the condition of his ideas, but also in his bearing and features, 
which previously fixed and stupid, were now doubly illumined by 
the restoration of sight and reason. 

These are the details of this extraordinary case, and as they 
are somewhat long, I will leave all comments and speculations 
upon them to those of vour readers .who may be interested in 
them, simply remarking that they have excited a great deal of cu- 
riosity and discussion among the savans of the Academy of Med- 
icine. The question which, with the facts before them, they have 
endeavored to solve is, whether this recovery of reason following 
the recovery of sight was a simple succession of facts, or whether 
it has a natural effect. M. Buisson sustains the latter theory 
with a great deal of vigor, and it is probable that the faculty will 
be on the look out for other cases of a similar nature, in order 
to further test the truth of his theory. At any rate, as an isola- 
ted fact merely, this case is an extremely interesting one. 

[Aid. tr Va. Med. Jour. 



On Hemorrhage from the Botoel^ in Children^ as a sign of 
Polypus in the Rectum^ By Thomas Bryant, Esq., F.R. 
C.S., •Assistant Surgeon to Ouy^s Hospital. 

[Polypus of the rectum is usually considered a rare affection ; 
but, within the last two years, at least twenty examples have fallen 
under the author's notice. The connection between hemorrhage 
from the bowel in children, and polypus of the rectum, is remark- 
ably constant. Mr. Bryant says :] 

in the majority of the cases which I have observed, the disease 
has existed for many months ; they have all occurred in children 
xmder ten years, and, in most, the disease has been regarded and 



On Hemorrhage from the BoweL 175 

treated for piles. In some cases the discharge of blood from the 
bowel is constant, and its buttocks smeared with a bloody mucus. 
In these instances the polypus will generally be found to be 
within, if not protruding from, the sphincter. In other examples^ 
occasional discharges of blood will be observed, although not to 
any very great extent, and this discharge will generally accom- 
pany and follow the act of defecation. In others, again, the 
hemorrhage will take place independently of any such process. 
There will, generally, be some straining after stool, but I have 
never observed any prolapse of the rectum; and although this 
disease is troublesome to the child, and of course debilitating by 
the repeated, if not constant hemorrhage, when once recognized 
it is easily treated and rapidly cured. 

The recollection that such a disease is not so uncommon, and 
that it is always associated with hemorrhage from the bowel, 
should at once lead the surgeon to examine the part with his fin- 
ger, when the growth will probably be easily detected. It is gen- 
erally situated about one or two inches up the bowel, and will be 
found to vary from the size of a pea to that of a large nut. In 
some cases more than one will be present ; they are always very 
moveable, and easily slip away from the finger upon anything 
like pressure ; and at times, some little difficulty is experienced 
in fixing them for removal. Such a practice is the only correct 
statement, being invariably followed by a successful result. It 
may be done by means of forceps or ligature ; and in many cases 
I have broken the polypus off its attachment by hooking my finder 
round its pedicle. No bad result has ever followed. The pedi- 
cle is always very slender, although it may be an inch or more in 
length. 

The structure of the polypus is very simple, microscopically 
presenting the ordinary characters of the fibre- cellular growths. 
After removal no subsequent treatment is required, and recovery 
may confidently be expected ; the rectum, however, should be 
carefully examined, so that a second polypus be not overlooked. 

I have thus briefly brought this small but not unimportant sub- 
ject before the notice of the profession, feeling confiaent that the 
existence of polypus of the rectum is not so uncommon as is gen- 
erally believed, and that such an affection is usually mistaken and 
treated for piles. In children, the presence of bleeding from the 
rectum should at once lead the practitioner to suspect the exist- 
ence of polypus ; and, when detected, its removal is the only cor- 
rect treatment. I have never had an opportunity of seeing a child 
suffering from piles, and believe that cases so described are gen- 
erally mistaken, and that, in reality, they are cases of the disease 
now under consideration. — Lancet — JVhrth Carolina Jour. 



176 PeriodicUy as a Character of Disease. 

Periodicity as a Character of Disease. By Richard Hughes, 
M.R.G.S., Surgeon to the Brighton OrthopoMlic Hospital. 

There is one disease — ague — of the phenomena of which pe- 
riodicity is an invariable characteristic. There are other affections 
— the neuralgia and nervous headaches— which very frequently 
assume a regular intermittent character. And occasionally, in 
the course of various diseases, a tendency to a periodical type is 
manifested. 

Quinine and arsenic are speciBcs in ague. They are hardly 
less valuable in neuralgia and nervous headaches. And when, in 
works on medicine, wo meet with the remark that sometimes the 
symptoms seem to ceme on periodically, it is generally coupled 
with the statement that in these cases quinine will be found of the 
utmost value. 

What is the rationale of the facts ? 

The cause of the regular periodic recurrence of the paroxysms 
of intermittent fever is discussed by Dr. Watson, in the first vol- 
ume of his Lectures on Medicine, p. 758. After passing in re- 
view the various theories that have been advanced to account for 
it, he leaves the subject as one altogether uncertain. CuIIen's 
hypothesis as to the influence of diurnal habit he thinks the near- 
est approach to the truth ; but admits that this will in no way 
account for the tertian and quartan types of ague. In this state 
of uncertainty, the peculiar poison — malaria — which causes the 
intermittent fever, has been generally regarded as the source of 
its periodical character. It is supposed to act in the way of a 
ferment in the blood ; and the zymotic process set up by it is sup- 
posed to have its regular development and decline, the paroxysms 
being its effect on the nervous system when the process attains 
its acme. When other affections manifest a periodic type, it is 
supposed that their subjects have either had ague or been exposed 
to malarious influences. On the other hand, quinine and arsenic 
are considered to be antidotes to the malarious poison, and thus 
to counteract its periodic influence in all affections which tend to 
assume that type. But I think I shall be borne out by general 
experience when I assert that periodic phenomena are manifest in 
many a case of neuralgia or other disease, when the hypothesis 
of malarious influence is altogether shut out. This theory, there- 
fore, in itself a priori most improbable, must be at once rejected. 

If, then, the periodicity of ague does not depend upon the 

f peculiar poison which occasions it, does it depend upon the pecu- 
iar portion of the organism which that poison affects ? This is 
universally acknowledged to be the nervous system — the sympa- 
thetic. 
Let me place one after another some of the principal pheno- 



PeriodieUy as a Characsttr of Disease. 1T7 

mens of the cold stage of ague, with those produced by galvani* 
zation of the sympathetic in the neck. 

In the cold stage of ague ^* the patient feels diilly ; the blood 
deserts the sapei^cial capillaries; he grows pale; his features 
shrink; his skin is rendered dry and roagh; his respiration is 

a nick and anxious ; his pulse frequent sometimes, but feeble ; all 
^e secretions are usually diminished ; may make water often , 
though generally he voids but little, and it is pale and aqueous ; 
his bowels are confined, and his tongue is dry and white*'' — Wat^ 
soriy op. eU.y p. 735. 

Let Dr. Brown-Sequard now tell us the result of his galTanis- 
ing the sympathetic in the neck : ** The pupils are dilated ; the 
eye- lids wide open; the globes protruding. Blood deserts the 
superficial vessels ; secretion is diminished or checked ; tempera- 
ture and all vital functions lowered." 

It is dear from the above that the essential phenomena (dimin- 
ished afflux of blood to the surface, check of secretion, and low- 
ering of temperature) of the cold stage of intermittent fever may 
be produced artificially by excitation of the sympathetic nerve, 
and are dependent upon the contraction of the blood-vessels there- 
by occasioned. The hot stage is no less explicable as the natural 
reaction of the vessels to even beyond their normal calibre, and 
find its precise analogue in the phenomena which results from 
section of the sympathetic in the neck. 

It would appear from the above that the sympathetic system is 
that part of the oreanism specially affected by toe malarious poi- 
son, and that the phenomena of a^ue depend on a periodic exci- 
tation of it by the poison, followed by an equally immoderate re- 
action in the opposite direction, which latter at length settles 
down to the equilibrium of health. And upon the hypothesis the 
beneficial influence of quinine and arsenic in this disease receives 
its perfect raiionale. For these are well known as (to use Dr. 
Handfield Jones' term) *' toners of the vaso-motor nerves" — i. e., 
of the sympathetic— and their tonic influence thus exerted will 
obviously render it capable of resisting the morbid irritation of 
the malarious poison ; a view of which is confirmed by the well 
known fact that quinine is no less valuable as a preventive than. 
as a curative agent against this malady. 

But will the fact of the sympathetic system being the seatr of 
the phenomena of asue help us to explain the periodic character 
of these phenomena? I think it will. Let us consider the- ao» 
tions of the heart and the uterus, two muscular organs supplied 
mainly or entirely by this nerve. 

What is the cause of the rhythm of the heart ? It cannot be 

the stimulus of the blood, or of anything else within the bodv: 

for a frog's heart will continue its regular systole and diastole for 

some time after its removal from the thorax. The only aiotave 

Vol. xn— 12 



178 Feriodieiiy as n Charcuiter (^Disease. 

ageooy then left to it is that of the sympsthetio gasglia, which 
are imbedded in its substance. To these neirous centres we are 
therefore shut in our inquiry as to the heart's action ; but the in- 
fluence of these centres is neither continuous nor occasional, but 
rhythmical, L e.^ periodic. 

The uterus resembles tho heart in its also possessing numerous 
sympathetic ganglia imbedded in its muscular walls, and in entire 
independence of the cerebro- spinal system in its movements. Is 
there anything here periodic ? We immediately think of the regu* 
lar monthly recurrence of the phenomena of menstruation, and of 
the act of parturition, which fas first shown by Drj^ Tyler 8mith 
in the pages of *'The Lancet^') is determined by the menstrual 
periods bmg normally due on the twenty- first day after the com- 
mencement of the last menstruation. * 

From the marked periodicity apparent in the action of these two 
organs, ezclusively animated by sympaihetic ganglia, we seem 
justified in the conclusion that a periodical evolution of nerve- 
force is characteristic of this division of the nervous system ; and 
if this be the case, we cannot be surprised that it should give its 
peculiar character to phenomena resulting from the effect of a 
poison upon itsell. Thus the periodic character of the paroxysms 
of ague is reduced under the mere general law of periocUc charac- 
ter of phenomena, morbid or natural, over which the sympathetic 
system presides, dependent upon the endowment of this system 
itself. 

It follows that periodic phenomena appearing in the course of 
any other diseases must be attributed to an involvement of the 
sympathetic system in their morbid irritation ; and thus the bene- 
ficial effects of quinine and arsenic in all such cases fall under the 
general law of their toning influence upon that system. I may 
instance the most common affection which inclines to a periodic 
type«»nervou8 headache. Dr. Symods, in his admirable Gulsto* 
nian Lectures upon this subject, shows by many arguments that 
the vascular nerve — s. e., sympathetic — of the brain and skull are 
the seat of padn in this affection • and, in common with general 
experience, regards quinine and arsenic as the sheet-anchor in its 
treatment. 

I venture to 'admit that the following original conclusions are 
established by the preceding considerations : 1. That ague is an 
affection of the sympathetic system ; 2. That its periodical char- 
acter is dependent upon a periodicity impressed upon the sympa- 
thetic system, and manifested in all the phenomena, morbid and 
natural, over which it presides ; 3. That tho modus operandi of 

* This theory shovld be more widely carried out in obetetric practice. I baTe 
been delighted at the ezactitude with which it has eoabled me to predict eyen the 
day of deilveiy. The advantage of such a pre knowledge, whether to patient or 
yoKtitloner* is immense. 



^edions of the Femak Sexual Organs. 1T9 

quinine and ftrsetuo in aene and other periodical affeetions is the 
toning inflnence exerted by them on the Bjmpathetic nerve. The 
doctrine also of the dependence of the hearths movements on its 
embedded ganglia, and of the menstrual periodicity as the deter- 
mining cause of parturition, receive no shght corroboration ; and 
our instinctive recourse to quinine and arsenic, whenever periodic 
symptoms manifest themselves, receive alike its rationale and its 
establishment. — Ohio Med. Jour. 



Urticaria as a Symptom qf Irritation of the Female Sexual 
Organs. By Prof. Sgawzoni. 

Prof. Scanzoni abserves that although it has long been known 
that chronic affections of the female sexual organs are not infre- 
quently accompanied by skin diseases, (urticaria, eczema, acne, 
psoriasis, chloasma, etc.,) the influence of a more sudden irrita- 
tion of these organs upon the cutaneous surface is by no means 
so well established. He has been enabled to find no very definite 
statements upon the subject, and this leads him to communicate 
some cases tending to establish such a consensus. 

A lady, aged thirty-five, had been under his care for some time 
with sli^t retroflexion of the uterus and chronic metritis, when 
he ordered four leeches to be applied to the vaginal portion of 
the cervix uteri. This little operation had been already perform- 
ed once before without any ill effect, but upon the present occa- 
sion, ten minutes after the application had been made, the patient 
was seized with violent febrile action, and slight delirium. In 
half an hour she was seen by the author, who found her skin, and 
especially that of the face and upper part of the body, almost of 
a scarlet red. The temperature of the surface was considerably 
raised, and her puke beat 186. She continued much the same 
during the night, and when seen next day, the face, neck, chest, 
arms, and thighs exhibited with the intense redness, innumerable 
urticaria elevations. In a day or two the exanthem had entirely 
disappeared, a distinct desquamation, however, taking place on 
the face and neck. As this was the first case the author had ever 
seen in which these symptoms followed the application of the 
leeches to the cervix, he dud not believe in their dependence upon 
this, and again ordered them to be employed. Four times this 
was done without any unpleasant occurrence, but on the fifth oc- 
casion the whole series of symptoms above described were repro- 
duced, and that so rapidly i^fter the biting of the leeches that any 
doubt as to cause and effect could no longer be entertained. 

In a second case, a woman, aged eighteen years, was admitted 
into the Wursburg Midwifery Institution on account of chronic 



180 J^ectiana f/the Female Sexual Organs. 

uterioe infarctas, and fi?e leechee were ordered to be applied to 
the cerriz. Scarcely had they taken hold, when she complained 
of the moat violent labor- like pains in the abdomen, and although 
these soon moderated in f oroe, they were accompanied with such 
intense febrile action that the entire body glowed with beat, the 
pulse rose to 140, the carotids pulsated visibly, and the face, 
neck and chest exhibited an intensely red color, to which were 
added in a very short time a large eruption of urticaria eleva- 
tions of a palish color. The eruption was accompanied by great 
headache, inclination to vomit, and excessive lassitude, symp- 
toms which continued to the following day — although the exan- 
them, with the accompanying fever, disappeared entirely after 
three hours' continuance. Tms patient often had suffered from 
urticaria at the menstrual perioos, without, however, its being 
accompanied by such violent symptoms. 

The third case occurred in the person of a young lady, aged 
twenty- six, who, on account of long -continued chronic oophoritis 
and metritis, required blood-letting. In the course of sixteen 
months, four or five leeches had been applied eight times. On 
the ninth occasion, an intense redness covered the skin, and the 
patient complained of the most violent pain in the head. The tem- 
perature of the surface was much raised, and it was almost en- 
tirely covered with innumerable, minute, prominent elevations. 
In the course of an hour these appearances gradually subsided, 
the headache continuing for twenty- four hours longer. The au- 
thor is aware of a fourth case of the same kind, but is unable to 
furnish the particulars. 

Prof. Scanzoni believes that these cases deserve the attention 
of those occupied with the diseases of women, as well as of der- 
matologists. They admit of no other explanation than the irrita- 
tion of the uterine nerves, caused by the bite of leeches, induced 
an entirely unusual, and in its mode of origin inexplicable, dis- 
turbance of the vascular system, which again, in a mode which is 
to us equally unintelligible, gave rise to the production of the 
eruption^ of urticaria. In proof that these appearances were not 
produced as a consequence of any poison being conveyed through 
the medium of the bite of the leech, it is to be observed that simi- 
lar symptoms never result from the application of leeches to 
other regions of the body, while it is to be observed • that even 
very slight irritation of tibte sexual organs, as that produced by 
examination with the finger or speculum, or by the application of 
caustic, will, in many sensitive women, give rise to erythema of 
the face, neck, breast, etc., which disappears as rapidly as it 
comes on. — Wurzburg Medicin. Zeitsdirifts. — JST. C. Med, 
Journal. 



On the Diseases of Printers. 161 

On the Diseases of Printers. By Dr. Van Holsbbbk. 

Dr. Van Hokbeek having enumerated the diseases resalting 
from over-work, from intemperance, want of cleanliness, vicious 
habits, protracted watching, etc., proceeds to speak of the morbid 
affections more specially belonging to the printers' art. Fissures 
of the lips, of varying depths, are of frequent occurrence ; at 
other times tumors are developed on the inner surface of the 
same parts, which are nothing else than follicles whose excretory 
ducts are closed. These tumors sometimes inflame, become 
highly painful, rapidly ulcerate, and assume a cancerous appear- 
ance. Such affections of the lip are owing to the habit some 
compositors have of putting into their mouth the types still moist 
with the fluid which has served to wash them. Dyspepsia is fre- 
quent, as is diarrhoea ; the latter is, however, of a transitory and 
mild nature. Among the most common affections are those of 
the respiratory passages, of which laryngitis and bronchitis are 
the principal; pleuritis is rare; pleuro -pneumonia is frequent 
and severe. These diseases are favored by the curved position 
which the printers are obliged to maintain during their work, par- 
ticularly when they correct on the forms, and still more by the 
night- work, by gas-light, by the dust and emanations in places 
often confined and badly ventilated. Nearly twenty- five per cent. 
of printers die of tuberculosis, either hereditary or acquired. 
Diseases of the heart prevail among the pressmen ; hemorrhoids 
are rare ; Tarioea and varicose uleers are of frequent occurrence ; 
the compositors who correct on the form frequently suffer from 
cerebral congestions and hsemorrhage. Amone nervous diseases 
we observe tremor of the hands, against which the author success- 
fully employs the electric current. Saturnine colic and paralysis 
are rarer than formerly, an improvement due principally to the 
difference in the composition of the materials of which the type 
is made, to the precaution of cleaning it from dust, as well as 
frequently rubbing the boxes which contain it ; lastly, to the care 
of the workmen, who no longer put the letters in their mouth. 
Hernia is common, particularly among the pressmen ; in them we 
occasionally observe distortion of the joints of the fingers. Fis- 
sures and callosities form on the thumb and index finger of the 
right hand, on account of the roughness of the characters, par- 
ticularly if they are new and damp with the matters with which 
they are polished; moreover, in consequence of the habit the 
printers have of washing themselves with alkaline water or bad 
soap. Amblyopia and myopia, so very prevalent among typogra- 
phists, terminate the sketch drawn by the author of the diseases 
of this interesting class of artisans, with whom we are in daily 
contact, and whose intelligence and diligence we have constant 
reason to admire. — Lo Sperimentale^ Dec.y 1859, p. 560. — 
Ohio Med. 4* Surg. Jour. 



182 Editorial. 



NBW TEST FOB DIABBTES. 

Dr. E. C. Bidwell communicates to the Boston Med. & Surg. 
Jour. (Nov. 22, 1860) a process which he claims as a new tost 
for glucosuria. His proposed test, he says, if not preeminently 
scientific, is nevertheless facile and reliable. He converts the 
saccharine element of diabetic urine into caramel^ by heat. Upon 
a clean slip of tinned iron are placed one or two drops of the sus- 
pected material, which is then held over a spirit lamp ; the fluid 
will speedily evaporate, leaving scarcely a trace upon the surface 
of the metal. The application of the beat is continued, and in 
a few moments after the completion of dessication, a spot, about 
an inch in diameter, over which the drop has spread with the first 
ebullition, will gradually assume a rich reddish brown color, with 
a brilliant lustre, having the appearance of Japan lacquer. The 
application of a stronger heat produces a darker, but the lustre 
continues until the intensity of tneheat decomposes the substance. 
Dr. B. claims great success in his experiments, with this new 
method^ which is far superior to those tests found on either fer- 
mentation, or on the reduction of metallic oxides, which latter, 
besides being complicated and inconvenient for clinical use, are 
liable to various fallacies. — •V. 0. Med. Mws tr Hospital 
Gazette. *--JV*. C. Med. Jour. 



PART IV. 

EDITORIAL. 

ST. LOUIS MEDICAL SOCIETY. 

At the annual meeting of the St. Louis Medical Society, held 
in January, the following officers were elected for the present 
year : President ^ M. M. Fallen ; Vice President^ J. T. Hodgen ; 
Corresponding Secretary^ P. W. White ; Recording Secretary y 
E. J. Marsh ; Treasurer^ Thomas Kennard. 

Publishing Committee — Montrose A. Fallen, James B. Wash- 
ington* J. S. B. Alleyne. 

Executive Committee — J. H. Watters, G. H. E. Baumgarten, 
U. H. Billingslea. 



Editorial. 188 

U. S. MARINE HOSPITAL. ST, LOUIS. 

There were admitted and treated in the U. S. Marine Hospital, 
St. Loais, under the care of W. M. MoPheeters, M.D., during 
the year I860, one thousand and thirty patients. Of these, 
986 were discharged cured, SO died, and 64 remained on hand 
and under treatment at the close oE the. year. From this it will 
be seen that the ratio of mortality was less than three per cent. 

Among the medical cases there were of intermittent fever, 141; 
remittent fever, 124; diarrhoea and dysentery, 119; bronchitis 
and pneumonia, 83 ; phthisis pnlmonalis, 15 ; rheumatism, 81 ; 
typhoid fever!, 16 ; erysipelas, 6 ; syphilis, 180 ; gonorrhoea, 29. 
Among the surgical cases there were 16 fractures and 4 disloca- 
tions. Of the fractures, one was of the femur, five of the tibia and 
fibula (two of which were compound), four of the arm and fore- 
arm, four of the clavicle, one of the skull, and one of the patella. 
The remaining cases were made up of miscellaneous, medical^ 
and surgical diseases. All the cases of fracture, with the excep- 
tion of that of the skull, recovered, without shortening or deform- 
ity. Of the thirty deaths, nine were from pneumonia, seven 
from diarrhoea and dysentery, four from phthisis, two from apo- 
plexy, one from hsemoptisls, one-each from fracture of the skull, 
pericarditis, hepatitis, cerebitis, typhoid fever, penetrating wound 
of the chest, and mania a potu. 



ST. LOUIS DISPENSARY. 

From the annual report of the St. Louis Dispensary, a charity 
sustained by private contributions, and under the medical charge 
of Drs. Elias J. Marsh, Thomas Kennard, and £. H. Bryan, we 
learn that from its commencement in May, 1860, to the close of De- 
cember, two thousand three hundred and sixty -two patients were 
treated and supplied with medicine. 

The table of diseases published (which, however, we omit) 
shows that malarial fevers, and other kindred diseases, formed a 
very numerous class during the summer and autumn months* 
In reference to the expensiveness of quinine in the treatment of 
these aflfections, the report states : ** Latterly, we have substitu- 



184 Ediioriat. 

ted for it (quinine) the chinoidene^ a medicine similar in its 
nature and action, but much cheaper. Having given this agent 
an extensive trial, we are enabled to state, that in nearly all 
oases we have found it to answer fully as well as the quinine 
itself." 

As regards the nationalty of the patients, 1317 were from 
Ireland, 802 from the United States, 187 from Germany, 68 
from England* 44 from British America, 11 from Scotland, 6 
from France, 6 from Sweden, with individual representatives from 
several other countries. The report goes on to state *^ from this 
it will be seen that the Irish composed more than one half of the 
whole number. Of the Americans most of them were the children 
ef Irish parents ; the number of adult Americans, or the children 
of American parents, were very small." 

From this brief and imperfect synopsis of the report, it will 
be seen that this Institution, although of recent date, is doing a 
good work, and therefore deserves to be sustained ; and we take 
this occasion to commend it to the fostering care of our City 
Council. It is located on O'Fallon street, near Broadway, in 
the midst of a population most of all requiring its aid. 



GRADUATES OF THE ST. LOUIS MEDICAL COLLEGE. 

At the annual commencement of the St. Louis Medical College 
held in O'Fallon Hall, Friday evening, Februry 22d, 1861, the 
degree of Doctor of Medicine was conferred by Prof. Chas. A. 
Pope, Dean of the Faculty, on the following gentlemen ; after 
which the valedictory address to the graduates was delivered by 
Prof. Chas. W. Stevens. 



Name. 


Betidenoe. 


Sal^oet of ThMlt. 


E. W. Ayres, 


Missouri. 


Anaesthesia in Parturition, 


John W. Bronaugh, 




Diagnosis. 


W. E. Brown, 




Parturition. 


Samuel L. Bolton, 




A case in Practice. 


George E. Chinn, 




Digestion. 


J. H. Carter, 




Ad Eundem. 


John H. Cramer, 




Scrofula. 





JBJiiarial. 185 


Name. 


BMidenoe. 


SattJect of Thetis. 


W. Armstrong CoIIinS] 


Missouri. 


Typhoid Fever. 


A. W. Chenoweth, 


u 


Ad Eundem. ^ 


Charles Davis, 


Illinois. 


Morbid Anatomy of the Tu- 
bercular Lung. 


J. H. Dodson, 


Missouri. 


Med'l Properties of Iodine. 


Isaac K. Fay, 


Illinois. 


Fibrin not Histogenetic. 


E. L. Feeban, 


Missouri. 


Diphtheria. • 


Stewart Gordon, 


Illinois. 


Disloeations. ^ 


B. F. Henderson, 


cc 


Bilious Fever. 


R. E. Howlett, 


Missouri. 


Definition of Disease.* 


Joseph L. Haw, 


" \ 


Anatomy and Physiology 
of the Liver. 


C. W. Hagen, 


4C 


Scarlatina. 


E. H. Hoffman, 


CC 


Phthisis Pulmonalis. 


T. S. Hawley, 


Illinois. !| 


The Importance of a correct 
Diagnosis. 


John Heinbaeh, 


Missouri. 


Tobacco and its Use. 


Henry Hanson, ' 


Illinois. 


Dislocations. 


Wflliam J. Judd, 


N. C. 


Diphtheria. 


Wm. A. Jackson, 


Missouri. | 


Parturition under extraor- 
dinary circumstances. 


W. T. Kirtley, 


u 


Erysipelas. 


Jas. Albert Koch, 


(C 


Continued Fever. 


A. Augustas Lyon, 


Miss'ppi. 1 


Functional Diseases of tho 
Heart. 


G. W. Love, 


Missouri. 


Ad Eundem. 


James Long, 


(t 


Etiology. 


Dills Dyer Lockhart, 


CC 


Congestive Fever. 


Frank B. Moore, 


CC 


Thesis Writing. 


JohnB. Miller, 


Ci 


The Crepitant R&le. 


R. W. McClelland, 


CC 


Typhoid Fever. 


W. G. McEisick, 


Texas. 


The Brain. 


P- S. O'Reilly, 


Missouri. 


History of Medicine. 


W. J. Peak, 


CC 


Acute Peritonitis. 


L* D. Rush, 


Indiana. 


Ad Eundem. 


John W. H. Ross, 


Missouri. 


Scarlatina. 


Wm. Frank Starks, 


CC 


Arterial Hemorrhage. 


J. F. Starks, 


CC 


Peritonitis. 


John A. Searcy, 


CC 


Inflammation, 



186 


EdUoHal. 


Name. 


Besidenoe. 


Subject of Thede. 


Edward C. Strode, 


Illinois. 


Diphtheria. 


Sol. W. Steigers, 


Missouri. 


Causes of Consumption. 


John D. Smith, 


a 


Ad Eundem. 


John D. Taylor, 


n 


Pneumonia. 


Janius Terry, 


n 


Deposits. 


J. J. Turner, 


Illinois. 


Pathology of Irritation. 


B. F? Taft, 


Missouri. 


S Medicine in the Nineteenth 
\\ Century. 


Williito D. Wilhite, 


• a 


Scarlatina. 


T. Am Winn, 


a 


Pharmacology. 


Paul C. Yatea, 


cc 


Pollution. 


J. M. Toungblood, 


c& 


Oxygen. 



Owing to the political and financial troubles of the country, 
and at the earnest request of the class, the session terminated a 
week or ten days sooner than usual. 



MEETING OF THE AMERICAN MEDICAL ASSOCIATION. 

Our readers will bear in mind that the next meeting of the 
National Medical Association will be held in Chicago on the first 
Tuesday of June next, instead in May as heretofore. 

God only knows what will be the state of the country at that 
time, or whether there will be anything left which deserves the 
name of national. But as the political convention which met in 
Chicago last spring contributed so largely to the present dis- 
turbed state of public afi'airs, it is meet that the profession should 
assemble in the same place, and endeavor by their wisdom and patri- 
otism to do something to preserve the constitution, and restore 
the body politic to a state of soundness and health. We hope, 
therefore, to see a large attendance from all sections of this broad, 
and once united and happy, but now unfortunately dissevered 
land. Even should we belong to separate and distinct confeder- 
acies, we, nevertheless, are all members of the same noble and 
catholic profession, which knows no sectionalism. Let us, there- 
fore, come together as brethren, having for our motto — ^The 
union of the Profession for the sake of the Union — or if need be, 
re-union, or reconstruction, or whatever else the ezigendes of the 
times may demand at our hands for the preservation of peace 
and harmony. 



Medical Mitceilany* 187 

TO CORRESPONDENTS. 

The commtmicatioQ of Dr. N. E. Jones of Centrevilley Ohio, 
on ^'Diphtheria/' has been received after a delay of considerably 
oyer a month, making it too late for this number. It will appear 
in onr next. 

We are also in receipt of several new works, which will receive 
due notice. 



MEDICAL MISCELLANY. 

EXPULSION OF A H0H(£0PAtH. 

The St. Louis Medical Society, at a meeting held on the 28d 
of February, after a thorough investigation of the subject, expell- 
ed from membership Dr. George S. Walker of this city for hav- 
ing adopted the homoeopathic heresy. In our next issue we may 
give the official proceedings. 

Woorara in Epilepsy. — ^The Baltimore Journal of Medicine 
states, that M. Thiercelin presented a paper to the French Acad- 
emy on the 12th of Nov. last, giving his experience with Woorara, 
in the treatment of epilepsy. He reports two cases of several 
years' duration, which were greatly benefited by the use of this 
agent. 

^n Heroic Suggestion as to the treatment of Hydrophobia. — 
A correspondent from Hillsboro, Illinois, in a letter to one of the 
editors of this journal savs : '^ I would suggest one grand experi- 
ment for the cure of hydrophobia ; that is, to trephine and sub- 
ject the brain to pressure, and thus in a degree suspend the func- 
tions of the nervous system. Now when we relieve the excessive 
nervous irritability, there is reason to hope that nature will be 
able to eliminate the poison, or else its effects cease before the 
patient is exhausted. It may be said that this is a dangerous 
remedy, but a dangerous remedy may be required for a danger- 
ous disease. 

Death of Prof. John W. Francis ofJVito JTorA.— We regret 
to learn through the daily papers of the death of the venerable 
Dr. Francis of New York, in the 72d year of his age. Dr. F. 
has long been a leading physician in the city of New York, and 
was justly esteemed for his talents atd for his many professional 
and social virtues. 



188 Medical MisceOant/. 

Vicarious Menstruation. — The N. ¥• Med. Press says : ** A 
German eirl, aged twenty years, had never menstruated normally ; 
but an tucer on the inner anterior portion of each tibia would 
break and bleed freely each month, quite regularly, since she was 
fourteen years of age. She had spent much of this time under 
the care of physicians, both in this country and in Germany ; had 
tried chances of air, diet, associations and travelling, both by sea 
and land, besides medication, but all to no purpose. Dr. McLaury 
found her, in August, 1859, suffering from periodic pains ; for 
the correction of which, he gave five grains of the iodide of po- 
tassa, with extract of conium ; for the menstrual derangement, 
the ordinary pill of aloes and iron, one night and morning ; the 
bowels moving too freely, after three days but one pill a day 
was ordered. In just eight days from the time she commenced 
this treatment, she had the first normal menstruation ; and the 
catamenia continued regular ever since, while the sores on the 
legs healed completely." 

•^ Move in the right Direction. — The New York Academy 
of Medicine have passed resolutions, declaring it derogatory to 
the dignity of the profession to publish cases and surgical opera- 
tions in the daily papers, or to suffer such publications to be 
made — such proceedings being the ordinary practice of empirics. 
They also forbid the publication of the transanotions of the acad- 
emy in any other than a strictly medical journal. The practice 
of inviting newspaper reporters to be present at surgical opera- 
tions — which has occasionally occurred in this city — for the pur- 
pose of securing *Hhe puff direct," is equally unprofessional, 
and should receive, as it justly deserves, the unqualified condem- 
nation of every respectable physician. We must, however, do the 
justice to state that this practice has never been resorted to, or 
permitted, by the better class of our surgeons. 

Glycerine as a Solvent for Belladonna. — ^M. Foucher recom- 
mends the solution of belladonna in glycerine, instead of water, 
for the purpose of applying it around the brow to produce dilata- 
tion of the pupil. The extract is thus prevented from drying into 
a hard crust, aud a greater certainty of absorption of the narco- 
tic is insured. 

[This wonld also be a good form for applying belladonna to 
the breast for the purpose of arresting the secretion of milk — one 
or two drachms of belladonna rubbed up in an ounce of glycerine 
and smeared over the breast ; the addition of thirty or forty grs. 
of camphor would be beneficial. — Eds.] 



Medical Miscellany. 189 

•^ Fruitful source of EpUepsy. — ^Dr. Demereaox states, as 
we learn from the Maryland & Virginia Journal, that in a nam- 
ber of cases examined into, he has traced the cause of epilepsy 
in the offspring to the intoxication of the father at the time of 
sexual intercourse. He thinks that the baneful influence of 
drunkenness on the part of the parent on the foetus, should be 
widely promulgated. It is certainly a strong argument, if argu- 
ments were needed, in favor of temperance. 

JS/iiric Jlcid in Intermittent Fever. — ^Prof. Hammond of Bal- 
timore reports in the Md. k Ya. Med. Jour., the favorable re- 
sults of a largo number of cases of intermittent fever treated 
with nitric acid. The acid was administered in doses of ten 
drops, properly diluted, three times a day. He remarks that he 
has rarely been disappointed in his expectations of its curative 
action, whereupon, ne adds: <* Besides liie fact that the nitric 
acid was equally successful with quinine in arresting the disease, 
the difference in the cost of the two articles is so greatly in favor 
of the former substance, as to render it an object of importance 
to make its curative properties more widely known." 

TTie Berkshire Medical Journal — ^We have received the 
second number, for February, of this new journal published 
monthly at Pittsfield, Massachusetts, and edited by Drs. Wm. 
Henry Thayer k R. Cresson Stiles, both of whom are professors 
in the Berkshire Medical College. It is to be issued monthly, at 
two dollars a year, and is devoted to the interests of rational 
medicine. The number before us presents a neat and attractive 
appearance, and gives evidence of being ably conducted. We 
very cheerfully place it on our list of exchanges, and whether we 
are hereafter to remain in the same political confederation with 
our new confrere or not, we yet both belong to the one indissolu- 
ble republic of medicine. 

Hydrocyanate cf Iron in Epilepsy. — The Cincinnati Lancet 
& Observer says : " Dr. G. S. Bailey, a retired physician of 
Iowa, states in a letter to the editors of the Journal of Materia 
Medica, that his only son, after having been treated six years 
for epilepsy with evenr remedy that medical skill could suggest, 
without success, was nnaily cured with the hydrocyanate of iron, 
by Prof. D. L. McQugin of Keokuk. The formula employed 
corresponds with the one used by Dr. Treat (Gin. Lancet k Obs., 
June, 1860, p. 388) : hydrocyanate of iron, one drachm ; pow- 
der of valerian, two drachms ; extract of Indian hemp, one 
drachm, being originally added by McGrugin. Make into one 
hundred and twenty pills. One of them is to be taken three 
times a day, gradually increased to four." 



190 Medical MisceUany. 

Virtues of Red Flannel. — ^Prof. Pepper, as reported ia the 
Medical and Sargioal Reporter says : *^ A very exeellent, gentle 
counter-irritant is the wearing of the ordinary, very coarse, thick, 
red flannel next to the skin. The popular belief of the wanning 
properties of this kind of flannel is not without foundation ; for 
It is asserted by competent persons that in the red dye stuffs 
which are used in coloring this flannel poisonous species of sumach 
enter largely ; and this explains the peculiar cutaneous eruption 
which is so often seen in persons wearing this coarse flannel, 
especially when new. Thus it may ser?e two purposes — ^protect- 
ing the body against cold and changes of temperature, while it 
acts at the same time as a counter irritant." 



Ovariotomy. — Dr. E. S. Cooper of San Francisco has success- 
fully removed an ovarian tumor, weighing eighteen pounds. This 
is, he states, his third operation in San Francisco, and the only 
one which terminated favorably. 

Succes^ul Operation of Tracheotomy. — Dr. GFreene of Saco, 
Me., reports in the Boston Journal, a successful case of trache- 
otomy, performed on a child four and a half years old for the 
relief of membranous croup, with entire relief. This is rather a 
rare result, and as such deserves to be recorded. Emetics and 
other remedies were used simultaneously. 

Physicians in the United States. — ^According to the Nash- 
ville Medical Journal, the number of physicians in the United 
States, (as heretofore comprised) amounts to 40,481. In Massa- 
chusetts ^ere is one physician to 605 inhabitants ; in New York, 
one to 611 ; in Pennsylvania, one to 561 ; in North Carolina, 
one to 802 ; in Ohio, one to 465 ; in Maine, one to 884, and in 
California, one to 860. These facts may be of interest to recent 
graduates. 

How to Improve the Taste qf Cod- Liver and Castor Oils. — 
The Louisville Medical News says: ** Cod-liver or castor oil, 
shaken up with an equal volume of water distilled off the leaves 
of the wild cherry-tree, in a manner similar to that directed in 
the Edinburgh or Dublin Pharmacopoeia for cherry laurel water, 
and left to rest forty-eight hours before separation, acquires by 
this simple operation an extremely sweet perfume and a^eeable 
taste of almonds ; the taste remains as long as the digestion 
lasts. Oil flavored in this way could be taken by many patients 
who reject it in its natural state. Castor oil is not affected in its 
purgative action by this process." 



Medical Miseettany. 191 

Retirement of M. Ricord.—The N. A. Med. Chir. Review 
mentions the fact that M. Ricord haa delivered his farewell lec< 
tore, and retired from the Hdpital da Midi, to which he has been 
attached for nearly thirty years, in oonsequeoce of a regulation 
now in force in Paris, compelling sorgeons holding official ap- 
pointments to give up their hospitals and clinical teaching at the 
age of sixty. This strikes us as an absurd tule, wholly unwor- 
thy of the llmperor of France. At sixty years of age, most men 
are in the very vigor of manhood. We have always admired the 
custom of the ancient Romans, who admitted no one to their chief 
council until he had arrived at the age of sixty ; but it seems that 
a physician must be dismissed from his post as a public teacher 
at the very time that his age and experience would qualify him to 
enter the Roman Senate. Is experience of no advantage in med- 
icine ? 

Quackery and the JViwspaper Press. — The American Med- 
ical Times states authoritatively, that the New York Tribune is to 
receive the enormous sum of j^31,000 for one year's insertion of 
a quack advertisement, in its daily, and semi-weekly, and weekly 
issues. With such powerful motives to aid and encourage quack- 
ery, can we expect anv thing else than that such corrupt and un- 
principled presses as the New York Tribune will continue to lend 
themselves as willing abettors to quackery ? They have the same 
motive, only in an increased degree, to shout for it, as the Ephe- 
sian artisans did to cry ^^Great is Diana of theEphesians !" 

Chromate of Potassa in Warts. — ^M. Blaschko recommends 
the following formula as one of certain operation, even in very 
old standing and inveterate warts : Chromate, grs. 1} ; lard, 3 i. 
M. To be rubbed in night and morning. 

Therapeutical Effects of Bromide of Potassium. — The 
Druggists' Circular says: **Dr. PfeiflFer of Paris has confirmed 
by his researches the opinions of other physicians as to the seda- 
tive eflfects of bromide of potassium over the generative organs ; 
he has found that the salt possesses a decided power of modifying 
abnormal erections and diminishing the frequency of seminal dis- 
charges. He has arrived at the conclusion that bromide of po- 
tassium exercises a special influence over the muscular part of 
the genito-urinary apparatus, and at the same time induces a 
characteristic modification of the secreting functions of these or- 
gans. Dr. Pfeiffer has administered it also with success in neu- 
ralda of the neck of the bladder. He commences with the dose 
of naif a centigramme every day, and increases it gradually up 
to two grammes a day." 



192 Medical Miscellany. 

Dyspepsia. — ^The Med. & Surg. Reporter gives the following 
preecriptioD, used by Prof. Pepper with advantage as a carmina- 
tive, &Cm in dyspepsia : ft— Creosote, gtt. x.; sodas carb. 3 ii.; 
tr. zinseberi 3 i.; tr. cardamon, 1 i.; sacchar.alb. 3 ii.; aqua cin- 
namon, S vi. Dose, a teaspoonCal three or four times a day. 

HonMopaihy at a Discount. — The Amer. Med. Gaz. says, 
that at the opening of the session of one of the homoeopathic 
colleges recently chartered, it was fotind that only three (/) stu* 
dents were in attendance, and neither of them was prepared to 
pay Buy fees! Whereupon, the facnlty dissolved, — the dose being 
too infinitesimal. If we have been correctly informed, this too 
is pretty much the history of a certain homoeopathic college not 
a tnousand miles distant from us. 

Biography of the late Dr. Drake. — Dr. Maffruder of Baton 
Bouffe, Louisiana, is collecting material for a biography of the 
late Prof. Daniel Drake of Cincinnati. All who have any letters 
or papers, or are acquainted with any facts or incidents which 
may be of value in the preparation of such a work, fLre requested 
to address Dr. M. as above. Dr. Drake was a medical philoso- 
pher, and an ornament to the profession of the west ; and as he 
was extensivelv known in this region, we mention the above fact, 
hoping that those who can will aid the author in his proposed 
laudable work. 

The Baltimore Journal of Medicine. — ^We have received the 
first number of this new Journal, edited by Professor Edward 
Warren, and take pleasure in welcoming it to the list of our ex- 
changes, and in cordially extending to the editor the right hand 
of fellowship. It is to be issued oi-monthly, and will contain 
not less than one hundred pages — ^price three dollars a year in 
advance. It presents a good appearance, and is filled with in- 
teresting matter, and is every way worthy of a liberal patronage. 

•Antagonism between Woorara and Strychnine — its use 
in Epilepsy. — ^The London Lancet says: **Prof. Vella, guided 
b^ the experimental researches of M. Claude Bernard, some time 
since completed a course of investigations in order to test the 
alleged antagonistic powers of woorara and strychnine, and his 
investigations considerably strengthened the belief, already preva- 
lent, that the two agents stand in relation to one another as poison 
and antidote. It would now appear that M. Thiercelin has ad- 
vanced a step further, and, strcnk by the counteraction of the 
artificially produced convulsions by woorara, has been led to ad- 
minister the drug in the treatment of several convulsive diseases, 
more especially epilepsy, and with most marked effect." 



THE ST. LOUIS 

MEDICAL MD SURGICAL JOUMAL. 

Vol. XIX. MAT, 1861. No. 3. 

PART I.— ORIGINAL COMMUNICATIONS. 

ARTICLE I. 

[For the St. Lonis Medical Journal] 

nAn Itinerancy to and through some of the Hospitals of Paris. 
By Dr. S. Pollak. 

(Continued.) 

The Hospice of St. Lazare^ and Le Dispensaire de Salubrite. 
These two institutioDS, though entirely separated and distinct, 
belong to each other, and they must be described together. The 
Hospice of St. Lazare is a hospital for the exclusive use of the 
licensed prostitutes of Paris. It contains 360 beds, under the 
charge of Dr. Glerc. 

Before proceeding, it is necessary to say something about the 
hygienic measures adopted by the Police of Paris in regard to 
prostitutes. I do it in the confident hope, that it may be pon- 
dered upon by every good citizen and philanthropist of the land ; 
that inquiries may be instituted, the inevitable result of which 
would be an immedia|te adoption of like measures by every muni- 
cipal government of the United States. If the good arising from 
them would only be one tithe of what it is here, we should be 
satisfied and grateful. It will never do to admit (it being an in- 
VOL. XIX — 13 



194 Foreign Correspondence. 

delicate subject) that it had better be omitted from the journals. 
It is a social, and I might add a necessary evil, which unfortu- 
nately exists everywhere ; in the country as well as in the towns, 
but in larger cities much more. To extirpate it is impossible ; 
but to lessen its dire results is perfectly in our power. Paris, as 
well as other cities where similar regulations have been intro- 
duced affords evidence of it. If we continue in the United States 
to adopt every thing which is of real practical worth, then the 
few measures which I am about to mention will find a counter- 
part in the United States of incalculable beneficial results. 

Every woman in Paris who lives by prostitution must be regis- 
tered at the Prefecture de Police, with her name, age, former 
occupation, residence, and the cause which led to this awful step, 
stated. These women are divided into two classes ; 1st. Les 
IsolSes, or filles en carte^ i, e., those who keep house themselves, 
live alone, and receive visitors in their own apartments ; 2d. Les 
filles de maison^ girls who live in houses of prostitution, known 
by the name of les maisons de lolSrance ; the latter are kept by 
a person, who is called ^< la Maitrtsse de Maison^^^ who is obliged 
to have a license from the Police, which is never given except 
with the knowledge and consent of the proprietor of the house. 
Such property is immensely valuable, but it is at once forfeited 
to the State if any serious disorders should take place in it. 
There are twelve physicians and one chief appointed, whose duty 
it is to visit these maisons de toUrance once a week, examine 
every one of the girls, who are obliged to be registered in the book, 
received from the police, of the mattresses de maison. The date 
and mode of examination are recorded in that book. If they are 
found healthy, nothing further is done ; but if unhealthy, they 
are forthwith ordered to the Prefecture de Police ; there again 
examined, and if verified, sent to the St. Lazare with or against 
her will. A prostitute loses her liberty as soon as she gets dis- 
eased. The police gets hold of her, and disposes of her in the 
most summary manner. There are not more than eighty such 
maisons de tolerance in Paris, averaging from ten to twenty 
inmates each. 

But of the IsolSes or filles en cartcj there are over 4,000 regis- 
tered. They are not visited, but have to present themselves at 
the prefecture de police once a fornight. There they are exam- 



Foreign Correspondence* 195 

ined most thoronghly, with the date of examination and result 
dalj recorded. If found in the least diseased, she is not suffered 
to go home, but is at once sent to St. Lazare. The date and re- 
sult of her examination is also plainly registered on their cards 
(license), which they are bound to exhibit to any visitor who 
may choose to demand it. 

There are of both classes between five and six thousand regis- 
tered. All these have to be examined twice a month. This 
makes 120 to 130,000 examinations a year, and all this is done 
by thirteen poorly paid physicians. 

To be admitted to visit St. Lazare, or the Dispensaire de Salu- 
brity, is, no easy matter. An especial permission of the Pr^fet 
de Police is necessary. He being a Minister, and one of the high- 
est functionaries of the empire, access to him is very diScalt. 
Application has to be made in writing, which has to be supported 
by our Representative. The Hon. M. Faulkner, to whom I am 
indebted for so many courtesies, at once affixed the seal of his 
office to my letter ; the door of the Minister of Police flew open 
to that talisman, and permission was granted. 

In the waiting room of the Dispensaiire de Salubrity were be- 
tween three and four hundred females in attendance. One by 
one they were called in ; they came, deposited their license — 
card — on the desk. While they were ushered in the next room to 
be examined, per speculum^ the register was carefully compared 
with their cards. If all in order, they were sent away, with a 
new stamp affixed to their cards ; but if not, they were sans cere- 
monie sent to St. Lazare. They are never prescribed for here . 
they are either returned healthy, or, if in the least indisposed, 
they are sent to the hospital. It is a singular sight to see four 
hundred females, young and old, pretty and homely, gorgeously, 
coquettishly, or indifferently dressed, come in wiUi all the non- 
chalance imaginable, make their bow, get up on the peculiarly 
prepared table, be examined, get down without taking even their 
hands out of the muff, all in less than a minute. Of the four 
hundred examined, not more than five were found slightly affect- 
ed. These were all JiUes en carte^ for the others are examined 
at the toUrance. None can escape being examined. After 2 
o'clock, the register is carefully looked over, and if one, who 
should have come, has failed to present herself, a policeman at once 



196 Foreign Correspondence. 

goes after her. No escape is possible. Now Ioo£ at the result. 
The public is afflicted with a moral evil, which experience and 
common sense know cannot be eradicated. The public authori- 
ties try, and most effectually succeed, in making it as harmless, 
physically speaking, as it possibly can be. For it is a well 
known statistically proven fact that in no city of the world, in pro- 
portion to its population, is syphilis less than in Paris. It is an 
unknown or at least a rare occurrence that one becomes infected 
from a licensed JUle. The admirable work of Parent Duclia- 
telet on *^ Prostitution in Paris and in other cities of Europe," 
has proven this most conclusively. 

And now to the St. Lazare. This is actually a female prison, 
containing about 1200 inmates, guilty of petty offences. A part 
of the ground, not of the building, is appropriated for a hospice 
for diseased licensed prostitutes. None other can be admitted, 
and to no other hospital can they be sent, or are permitted to go. 
The Lour cine J as you know, is also a hospital exclusively for 
syphilitic females ; but it is not under the control of the police. 
Syphilitic females from all classes of society, except licensed 
prostitutes, go there; the latter are all consigned to the St. Lazare. 
I attended one of the visits, and I had enough of it. I acquired 
all the information I desired. As in the Lourcine, the physician 
does not go to the beds, but the patients come into his cabinet; 
one after the other are speculated^ prescribed for, or otherwise 
attended to, and sent away. The forms of syphilis there are 
necessarily mild. It never could have had an existence of more 
than a fortnight, for they were previous to their admission exam- 
irted at least once every two weeks. The visit over, they are set 
to work ; they do all the house- work, take in sewing, etc. They 
are superintended by the Sisters of St. Mary and St. Joseph^ 
who, with that true Christian devotion due to their order, road to 
them, instruct them, lecture them, and endeavor to bring about 
a moral reform, whilst at the same time carnal evils are attended 
to. Many times they succeed in reclaiming and entirely reform- 
ing some of these lost ones. Daily, morning, and evening pray- 
ers are held in the sick-rooms, and Sundays in the chapel. There 
is also a Protestant oratory there, for the special benefit of those 
who may be Protestants. There is much liberality shown here 
in that respect. But not enough praise can be bestowed upon the 



Foreign Corre$pondenct. 197 

Siaiers of Si. Maty and St. Joseph^ who make tho moral re- 
form in prisons their object. ^They speak of establishing them- 
selves also in the United States. Give them a hearty welcome. 

The treatment of syphilitic cases is extremely simple there. 
For the primary symptoms nothing but loeil applications and 
strict regimen. In the secondary, the proto-iodide of mercury is 
the main reliance. In the tertiary, the iodide of potassium is 
the sheet anchor. They are kept under observation a needlessly 
long time. Nothing can exceed the manifestation of joy when 
one of these nymphs obtains her cong6. 

The prison- part of St. Lazare, although out of my line, I could 
not resist seeing. It is more of a reformatory than of a peni- 
tential character, being similar but superior to our house of 
refuge. Here, also, the ministering angels, ^^ the Sisters of St. 
Mary and St. Joseph,'' have the management of the inmates. 
Neatness, propriety, industry, are met with at every step. The 
influence of these sisters is indescribable. Many go out better- 
ed — some of them entirely reformed. Instances of Magdelenism 
are not wanting among them. 

Among fifteen hundred females, all in active exercise of sexual 
functions, pregnancy is not a rare occurrence. There is neces- 
sarily a part of St. Lazare appropriated for parturient women. 
It is just as good an obstetrical school as that of the Hdpital des 
Gliniqnes. The children born there are only kept six months at 
the furthest in the institution, and they are never permitted to 
learn the place of their birth. 

I regard SL Lazare and the Dispensaire de Saluhrite as 
the most important institutions of Paris, both in a social and a 
medical point of view. It should be visited by every American 
physician coming to Paris, and its utility made known, regardless 
of the obloquy which the subject may occasion. The benefit of 
similar institutions with us would soon be felt, and become of 
general municipal adoption; the fearful progress of this most 
loathsome disease would be stayed ; the many crimes perpetrated 
in the houses of prostitutes would be necessarily abated. All 
the posl-facto punishments are not of half the avail as the above 
enumerated police and sanitary regulations. Were these facts 
known in the United States, I have no doubt like measures would 
soon be adopted, and meet with general favor. 



198 Foreign Correspondence. 

The HdpUalde la PiliS^ of five hundred beds, is under the 
charge of the following staff of medicins : Gendrin, Narrotte, 
Noel, Gueneau de Mussj, Bequerel, Bermutz ; and of the chirur- 
giens: Maisonneuve and Michon. This is another of those old, 
tumble- down hospitals of Paris which ought not to be suffered 
to exist. It is braced up by iron bars, else it would certainly be a 
heap of ruins. It is kept, as all other hospitals, in perfect order, 
and every bed is occupied. 

The great lights in the medical department are Bequerel and 
Mussy. Though able and learned, they are yet poor teachers. 
An attendance at their cliniques is a waste of time. 

In the surgical department is Michon, an amiable and able 
man and a good teacher. His cliniques are always instructive. 
He is plain, unassuming, but a good diagnostician, a sympathising 
and successful surgeon. He takes pains to explain the why and 
wherefore of his views and actions. They are in the main ra- 
tional and up to the present state of medical science. 

But Maisonneuve is the star of attraction. He is, by all odds, 
the boldest, nay, the most audacious surgeon, and the roughest 
and most brutal operator. His examinations are unpardonably 
painful. There is never a necessity for such a savage proceed- 
ing. There is an absolute want of sympathy for the sufferings 
of his fellow-men. I know the surgeon's examinations and sur- 
gical remedies must be necessarily painful ; but these pains should 
not be unnecessarily increased. He will undo and do the dress- 
ing of every patient; and the brutality with which this is done is 
in the highest degree reprehensible. But he remains an object 
of admiration when handling a surgical instrument. He is rapid 
in his diagnosis, and his operations are quickly and skillfully ex- 
ecuted. N^laton temporizes, requires time to mature a plan ; 
Maisonneuve, never. He never defers action — is always prompt 
and ready, and I dare say successful. 

A patient came from another hospital, declared to have a /?a- 
ralysis of the right arm. In a moment's examination, ho de- 
clared it to be an ** anchyhse arihritque.^^ With a few vigor- 
ous and rapid movements of the patient's arm, which made him 
faint, but which stopped all further resistance, he broke up the 
arthritic adhesions, and the patient, on coming to, used his arm 
with ease. Another patient was sent him by Yelpeau, who would 



Foreign 4^Tenpandence, 199 

not touch him, but advised him to go to Maisonneuve, who would 
do what no one else would venture. It was an enoephaloid tu- 
mor, involving the whole left side of the neck, from the mastoid 
process down to the acromion. Even Maisonneuve feared to use 
the knife. He applied the ^^ caut^re tflhche^^ He made about 
seventy or eighty punctures with the bistoury in the healthy pa- 
rieties all around the tumor, and then thrust deep in a caustic, 
made of chloride of zinc and starch, of equal parts, which are 
made into a dough, rolled out with a pin, and then cut in long 
slices, somewhat in the shape of an arrow, and of unequal length. 
They must reach deeply so as to cauterize the very root and 
foundation of the morbid growth. The tumor was well detached 
on the second day. The patient did not suffer much, but there 
were left exposed to view and touch all the large vessels of the 
neck. 1 asked him, whether he did not apprehend that the caus- 
tic would affect these blood-vessels and cause a fatal hemor- 
rhage ? He said, that, in his experience, the caustic never affects 
a healthy tissue, which offers very great, although perhaps not 
insurmountable resistance to its effects ; that if the blood-vessels 
were in a healthy condition, they would not be affected by the 
caustic ; but if not, any other method would have been equally 
fatal. However, the patient does well. 

Here, also, is the plaster of Paris used exclusively in fractures, 
both simple and compound and complicated. Maisonneuve is the 
very image of our worthy townsman, Dr. Engelmann. It would 
be very desirable if he would adopt also some of his gentle man- 
ner and kindness to his patients. One can only go to see him, 
but not to imitate him. His roughness is only equalled by 
his waste. Such a needless use of bandages, lint, etc., is un* 
pardonable, and still less his manners to patients and his aides* de* 
camp. A little setting -down might do him good. 

The Hdpztal JVicker on the rue de Sevres has 402 beds, 220 
for males, 182 for females ; is under the charge of Ouillot, Mon* 
neret, Yemvis, Bouley, as physicians, and Moret Lavall6e as 
surgeon, and Civiale as lithotritist. This institution was once a 
Benedictine convent, but since 1T79 has been converted into a 
hospital. Like all buildings whose destination has been changed, 
it is illy adapted to its new purpose. Though large sums have 
been spent on it, the inconveniences are numerous. Even the 



200 Foreign Corre$]^ndence. 

charitable and intelligent Madame Necker, who devoted her for- 
tune and her life to it, could not make it what it should be. 

The cliniques are about the same as in the other hospitals. 
There is no great light among any of the chiefs. The main at- 
traction is doubtless the veteran Civiale, who only deals with uri- 
nary diseases, or rather with diseases of the urinary organs. 
Hence strictures he claims as his special province, though mainly 
arising from venereal causes. It is comforting to hear him say 
that obstinate strictures should and can only be treated success- 
fully by division ; and again the not less eminent M. Clerc de* 
dares that nothing but dilatation will do. Civiale insists be- 
sides that the fibres in the strictures of the perineal portion of 
the urethra are not dilatable, and must be cut. His urethrotome 
acts admirably and with perfect safety. He rejects the division 
of the urethra from without, and says he has never never failed to 
overcome all resistance, with different sized urethrotomes. He 
also uses the last instrument in order to prepare the way for the 
introduction of voluminous lithotrites. Civiale is very aged, but 
very pleasant in his manners, a good teacher, and a good rider 
of his hobby lithotritie. He only holds clinique on Saturday. 
Nearly always the same patients are brought into the amphithe- 
atre, to have a small piece of the stone broken off and removed. 
It is both a tedious process and a painful operation, and exceed- 
ingly doubtful in its result. The introduction of large volumi- 
nous instruments into the urethra is extremely painful, requiring 
weeks of training or dilating before a person can endure it. It 
requires the utmost skill, and very long experience, to find and 
to catch the calculus between the branches of the lithotrite, then 
crush and remove it. It is usually only a small quantity which 
comes out, and that which is left behind serves as a nucleus for 
a new calculus. It takes months of treatment of lithotriting pa- 
tients, and then with equivocal results. 

I saw him attempt to perform the hypogastric operation to re- 
move a large calculus, but he failed owing to having wounded 
the peritoneum. He of course adjourned the operation, not 
daring to puncture the bladder, and run the risk of having the 
urine get into the abdominal cavity. The patient was of 
course removed ; he kept his stone, and got a gap four inches 



Foreign CorreMpondenee. 201 

long in the linea alba into the bargain. What he is going to do 
next with him, I will endeavor to ascertain. 

19th. — I saw the patient since I wrote above ; the wound healed 
by first intention, Civiale spoke of him in to-day's (nineteenth) 
clinic, and said he would now perform the lateral operation, 
crush the stone^ and remove the fragments. This is the third 
time I have seen the hypogastric section attempted, and always 
with the like issue. But why Civiale does not break up the stone, 
and remove the fragments by the lateral section, I cannot learn. 

I have never been a partisan of lithotritie, and indeed it ap- 
pears to have made only little progress in this world. Of all the 
Parisian surgeons, it is only Guersant who occasionally prac- 
tices it, and then only%r major reasons. Without wishing to 
deprecate the practice, they prefer sending all suitable cases to 
Civiale. I dare say, after his death, it will be little thought of in 
Paris, or elsewhere, for reasons already assigned, niimely: Ist, 
it being excessively painful ; 2d, uncertain in its result ; and 8d, 
interminable in its process. 

There is also in the Hdpital Necker a salle des nourriceSj a 
ward of nursing women. If either a nursing woman or a nursing 
child requires admission, both must be taken to it at once. — 
Mother and child are never separated. A humanitary and ra- 
tional measure, worthy of all praise and imitation. 

The Hdpital des Enfants^ on rue de Sevres, is contiguous to 
the above, and has 625 beds ; 321 for boys, 305 for girls. 
Blache, Roger, See, Tessier, are the physicians ; Giraldes, the sur- 
geon, and Bouvier, the orthopedist. It is under the management 
of the Sisters of St. Thomas de Viileneuve, whose intelligence and 
devotion to the children are beyond all praise. Sister Lamoureux 
is a Parisian celebrity. Her coup d'oeil is worth twice as much 
as the most learned diagnosis of the chiefs and internes. There 
is a deference paid to her superior intellect, her unbounded expe- 
rience, even by the savants of the profession. The attachment 
of the little children to her, and to her numerous coadjutors, is 
touching in the extreme. Nothing can exceed the cleanliness, 
neatness and order prevailing in this institution, where there are 
none but children. Three thousand one hundred and fifty- four 
patients were admitted in 1860 into this hospital ; of which, one 
hundred and fifty-six cases were croup, among which tracheotomy 



202 Foreign Correspondence. 

was performed one hundred and twenty-six times, and in three 
oat of ten with a good result. Rather startling statistics, bat 
true, as they are taken from the hospital register. More exten- 
sive statistics I will be able to furnish shortly, for 1857- '58. 
Dr. Millard's thesis for the doctorate treats this interesting 
subject in a most masterly manner. I will translate copious ex- 
tracts and place them at the disposal of the St. Louis Medical and 
Surgical Journal. 

This large number of cases of tracheotomy may be justly con- 
sidered as over- doing the thing here; still allowances must be 
made. Children are brought in from all parts of the city in 
nearly an asphyxiated condition, and tl^ operation may be the 
last resort in these desperate cases. tM Internes and even the 
Externes are permitted to perform the operation, without advising 
the chief of it. In cold damp weather, they average two trache- 
otomic operations a night. They have hardly ever to perform it 
in the day time. Group and diphtherite are considered in Paris 
as absolutely one and the same thing. They operate in croup 
only when the false membrane is limited to the larynx and tra- 
chea; but i^hen the soft palate and tonsils are covered with the 
membrane, especially when the submaxillary glands are enlarged, 
when there is fetid odor, they never operate. They regard the 
case as hopeless. The mortality among the children in these hos- 
pitals is fearful. Diphtherite has been endemical in Paris for sev- 
eral years past, and they are not further advanced there than we 
are in the treatment. The chlorate of potass and the perchlorate 
of iron and nitrate of silver are their chief reliance. To the 
smallest operation performed here, even after the application 
of leeches, erysipelas supervenes. Though death does not often 
ensue from it, it is nevertheless a grave complication, and ren- 
ders recovery very slow. 

Gymnastics is one of the chief therapeutic agents used in this 
hospital, and, indeed, it cannot be too highly valued. All over 
Europe, I found in schools and hospitals extensive gymnastic 
apparatuses, under the supervision of a scientific gymnast, who 
has to have such exercises executed as the physician may recom- 
mend. Each patient gets his regular gymnastic prescription, 
wherein the different exercises are nomenclated, the frequency and 
quantity of it carefully assigned. The journal is carefully kept, 



Foreign Correspondence. 203 

every incident and immediate eflfect recorded, and eqnallj as care- 
faUy entered into the clinical reports. 

Is it not time that the United States should follow this lauda- 
ble example, not only in the schools, bnt also in the hospital?? 
Eveiy hoar's delay will only be a detriment to the rising genera- 
tion. Gymnastic apparatuses should be put up and used only 
under the direction of a physician ; a well taught and intelligent 
. gymnast should see them well carried out. He is just as indis- 
pensable to the physician as the apothecary ; for, unless the right 
kind of exercises are made, and these well carried out, more mis- 
chief than good will arise. 

It sounds strange to bear at the clinique report : ^^ A. B. took 
exercise No. 1, 3, 9, 13, etc. ; 1 fatigued after ten seconds ; 9 
after twenty seconds ; 1 did not fatigue, etc.'' An importance 
is attached to it which is not overrated. May it soon find a gen- 
eral imitation with us. 

Tessier, one of the chief physicians in this hospital, treats his 
patients homaopathicalty. In examining the records and en- 
quiring of the director, M. Imard, I could obtain no satisfactory 
explanation. These were his words, almost verbatim : M. Tes- 
sier is elected by concours as a regular physician ; once appoint- 
ed, he can treat his patients as he pleases ; consequently his 
mode of treatment is only tolercUed^ not prescribed. The ad • 
ministration g^n^rale does not acknowledge it, but simply toler- 
ates it. Besides, he added, the wards of M. Tessier contain only 
les scrofuleux, les tiegnes, et les dartreux, (scrofulous, scald 
heads, and herpetics,) which require little othidr treatment than 
cleanliness and good diet. However, his prescriptions for other 
remedies are abundant in the pharmacy of the hospital. He also 
uses up large quantities of cod-liver oil, wine of quinquina, etc., 
which are furnished to each ward in abundance, without an extra 
demand of the physician. 

M. Tessier was for several years in the hospital Beaujon — ^had 
charge of a ward. I will glean all the information possible. 
Tou know me well enough to believe that I will do it with the 
view of eliciting truth, and not with the intention of finding fault. 

Hdpital Ste. Eugenie^ only open since 1840, under the name 
of Hdpital Ste. Marguerite. The present Empress having richly 
endowed it, in 1864 it assumed its present name. Like the pre- 



204 Foreign Correspondence. 

vioas one, it is for the exclusive use of sick children ; has about 
460 beds. Barthez, Bouchat, Bergeron, are the physicians, and 
Marjolin the surgeon — all very able men. It is under the charge 
of Sisters of Charity. Being in a more populous and in a man- 
ufacturing part of the city, (rue faubourg St. Antoine,) the char- 
acter of diseases is somewhat different, and surgical cases prevail. 
There are a great many cases of fractures : the courteous and 
eminent surgeon Marjolin had several set in one clinique in my 
presence, in order to give me an opportunity to learn fully his 
system. Here, as in all other hospitals of Paris, the immovable 
apparatus is used. They agree upon the principle, though the 
means vary. In many, the plaster of Paris is used ; in others, 
the dextrine (parched starch), etc.; but in St. Eugenie, Mar- 
jolin uses the starch scuUete, made of ordinary packing paper. 
He prefers it to cotton or linen, because it does not contract. 
It is a beautiful, simple, light, and solid apparatus. (He is emi- 
nently successful in his treatment of fractures.) It is ensily ap- 
plied, and always without complaint. I am glad the days of 
splints are passed. Neither in Berlin, Brussels, nor Paris, did I 
meet with one« I hope they will be abolished in the United 
States. 

An interesting case of a iumeur sanguine^ of eleven years' 
duration, seated on the submaxillary bone, operated on many 
times, always with fearful, alarming hemorrhage, was the last 
time punctured by Marjolin, and perchlorate of iron injected, with 
good success. It is not a nsevus, but has its seat under the pe- 
riosteum. I have got the case in printed form, and will either 
translate'it first, or send it on, and let you do it. 

Erysipelas and diphtherite are very abundant here. Insuffla- 
tions of tannin, alum, or both combined, are much used by Barthez, 
and with success. It is easily done by means of a simple india- 
rubber ball, attached to a wooden tube, the orifice of which is cov- 
ered with a septum of muslin. The tube contains a small quan- 
tity of the above remedies finely pulverized ; small pressure on 
the ball will at once blow it over the soft pa^late, epiglottis, and 
during an inspiration even into the larynx. Being readily solu- 
ble, it causes no inconvenience, and produces the same and better 
effect than sponging, but minus its annoyance. 



Treatment of Diphtheria. 205 

ARTICLE II. 

Diphtheria. — Belladonna in its Treatment. By N. E. Jones, 
M.D., of Circlevilley Ohio. 

Mssrs. Editors: 

In your joarnal, for September and October last, are some perti- 
nent and instructive remarks upon diphtheria ; a disease which has 
extended oyer this section of country epidemically during the past 
four months. 

Theoretically diphtheria has been pretty fully if not satisfac- 
torily discussed. The thing which interests, and is of importance to 
the public and to physicians is, ^' what will diminish the mortality 
and divest the disease of the fearful consequences that now mark 
its steps over the States?*' *' "What treatment will modify grave 
cases favorable to health, and, more than now, prevent milder ones 
assuming formidable complications. Dr. White, in his remarks 
before your Society says of this disease, <^ different remedies of 
a kindred class may be suitable in one and contra-indicated in 
another case.'' This is undoubtedly true to some extent, so far 
as idiosyncrasy may exist among individuals ; but ordinarily medi- 
cinal remedies act as modifiers with a commendable degree of 
certainty ; while epidiemical impressions upon the organism are 
even more uniform than our best therapeutical agents. 

The same disease may differ in its symptomatology in different 
individuals ; the manifestations arising from alike impressions 
may not correspond in each and every case ; but the primary im- 
pression being the same, and dependent upon the same cause or 
causes, they will alike be mitigated, modified or removed by the 
use of the same class of curative agents. 

There are in the treatment of disease medicines which we say 
constitute the basis, and then, according to circumstances, we may 
have adjuvants and corrigents : the basis may enter into the treat- 
ment of every case ; the others to meet special indications that 
may arise or be found existing. Quinine is the curative agent, the 
basis, in the treatment of marsh fever ; cathartics, alteratives, and 
anodynes, may or may not one or all be necessary to the more 
successful treatment. Quinine, however, being the curative agent, 
is given equally successful in all the various manifestations aris* 



206 Treaimeni </ Diphtheria. 

ing from this same epidemic or endemic cause. This we give 
merely to better illustrate our confidence (not in specifics) in 
curative agents, being alike adapted to the great majority of cases 
of disease excited by the same cause, and which produces that 
uniformity of manifestations in the organism we term epidemic 
and specific. 

Not to theorize — we come to you and your journal in. consulta- 
tion: What is the treatment for diphtheria? Dr. White says, it 
resolyes itself into 

I. To arrest the exudation by constitutional treatment. * 

II. To remove the exudation by local remedies, and 
ni. To guard the organism against sequelae. 

To arrest the exudation by constitutional treatment is the im- 
portant point : this first fully embraces the second ; and, we wbulil 
amend Dr. White's arrangement, with due respect, by substituting 

I. To arrest the constitutional manifestations and exudation, 
and 

n. To guard the organism against the sequ^lds. 

To remove the exudation by local remedies has never in our 
observation or experience been of the least advantage, and we 
feel confident, many times, great mischief has followed the appli- 
cation of caustic, astringent and stimulating applications. If 
the exudation is within reach of topical applications it is per- 
fectly harmless, and the patient will recover quite as rapidly w;ith- 
out as with them ; and when extended where it endangers life, 
unfortunately the trouble is beyond their reach, at least, to a de- 
gree which makes them all alike equivalent to failure. As regards 
the use of iodide of potassium as an alterative we have not (after 
considerable experience) the most remote confidence In its power 
to cause the arrest of ezudatioa. 

The chlorates, topical applications, newspaper recipes, and 
gospel specifics, have alike produced numerous recoveries, while 
many have died here and elsewhere under all kinds of treatment ; 
the truth being, as every intelligent physician knows full well, that 
most if not all the would-be cures are to be attributed more to 
the nature of the attack and curative forces of the organism than 
to any one or all the remedies used. The cases that would prove 
fatal without treatment have died with treatment. Therefore it 



Treaimeni of Diphiheria. 207 

is not of 80 macli importance wliat will shorten the duration of pain 
or fever, as what will arrest consequent fatality. 

The administration of quinine in free doses daring the early 
stages of the disease in this and other ague distiicts has seemed 
condnci?e of greater benefit than any other remedy in extensive 
use; yet, quinine alone or in conjunction with the chlorates or 
iodide of potass, or combined with iron and topical applications, 
has so o/ten failed in our own hands and under the supervision 
of other practitioners, that our confidence in them singly or com- 
bined, to favorably modify, arrest or prevent fatal exudation, is 
quite annihilated. 

In the abandonment of one idea or object for that of another, 
we freely admit is not the least surety the one in possession is 
any way more meritorious. But the success which has attended 
the administration of belladonna by way of experiment at differ- 
ent periods of over three months, has induced these remarks ; 
not that the field has been sufficiently extensive or experiments 
protracted to establish anything but to call the attention of the 
profession in localities where the disease now exists to these hints ; 
that they may make further observation upon what has seemed to . 
us a most potent remedy in arresting the constitutional disturb- 
ance and exudation. The impression of belladonna upon the 
nervous system and its specific action upon the fauces and larynx, 
might seem philosophically enough to warrant its administra- 
tion. And our experience so far would tend to establish 

I. Belladonna given to intoxication arrests membranous exu- 
dation • 

I[. Given early in the febrile stage cures by resolution. 

III. Causes softening and detachment of exudations in an unu- 
sually short space of time. 

The remedy should be pushed to slight intoxication or delirium. 
We give it in solution of chlorate potas. every hour, until mani- 
fest impression is produced ; then diminishing the dose and in- 
creasing space of time so as to keep up steady action of the drug 
for twenty* four to thirty- six hours; continuing the treatment 
with quinine and iron. This with us has been either accidentally 
fortunate or remedially beneficial above any other treatment adopt- 
ed, taking into consideration the nature of most of the cases 
where the belladonna was instituted. We allude more particu- 



208 Diphtheritis or Diphtheria. 

larly to those cases with great constitutional disturbance or croupy 
cough, with heavy exudation on posterior margin, tonsils and relum 
palati, and which too often under ordinary treatment soon run 
into distressing dyspnoea and death. 

We speak with a knowledge of the many fallacies in medicine, 
when we say belladonna has appeared to exhibit a most singular 
and satisfactory influence not only over the constitutional dis- 
turbance but also the existing local manifestations of diphtheria, 
and we solicit a fair and impartial test. We do this from the 
fact, there are cases where ordinary treatment if not useless is 
inefficient, and in calling the practitioner from that path which 
has a thousand times proved the road to death ; nothing may be 
lost, although this, too, may prove incompetent to the emergency 
of the sufferer. 



ARTICLE III. 
DIPHTHERITIS OR DIPHTHERIA. 

Pharyngocace^ Angina Gangrsenosa sen Pestikntialis. By 
A. DB Lezyksei, M.D., of Paducahj Ky. 

The character of this disease is typhoid, I classify it with 
the typhoids of the mucous membranes. 

Not intending to enter, at present, upon a long discussion of 
its physico-chemical nature, since I leave this for a future day, I 
shall confine myself to the most necessary points. Diphtheritis 
assumes three periods, according to which the symptoms will be 
of a different character : 

1st. Periody of irritation. — Symptoms, — The patients com- 
plain of some pain when swallowing. The fauces appear slightly 
reddened, and one, rarely both tonsillse are swelled. The voice 
becomes hoarse ; no fever. This status will last from five to 
twenty- four hours, and changes into the 

2rf. Period^ of secretion. — The fauces are livid, their mucous 
membranes are covered with a product that, at first, appears pel- 
lucid, but soon assumes a whitish, ashen, yellowish, then brown- 
ish hue, and soon becomes firm enough to be torn off with a for- 
ceps. Beneath this pseudo- membrane the mucous membrane 



Diphiheritis or Diphtheria. 209 

appears covered with dots of extravasated blood, which, although 
infiltrated, is entire. (It is said, by good authority, that even 
external erosions, /. 2., the surfaces of blisters, are, at this time, 
covered with these peculiar products. ) If art does not interfere, 
this pathological product increases rapidly, involving the mucous 
membranes of the mouth and air passages, and enters the ear by 
means of the eustachian tube. Deglutition becomes difficult, the 
salivary glands and mucous membranes of the mouth secrete a 
corroding saliva and mucus. The skin is dry and hot ; the pulse 
weak and rapid ; the psyche depressed ; the f aBces retarded ; urine 
brownish, reaction sour, its secretion is scanty ; the breath, at 
first sweetish, soon becomes very offensive. Duration of this pe- 
riod is from three to six days. 

Zdj Peri'jd^ that of gaiigrenesctnce, — Like all typhoid pro- 
ducts, the pseudo-membranes formed by this process originate 
from albuminous exudations, and like them are subjected to soft- 
ening and necrosis. In consequence of the latter, the tonsils, 
soft palate, the uvula, and portions of fauces, corrode in the man- 
ner of any other gangrenous ulcer. The breath is insufferable. 
Every other symptom is that of ^Hyphus gravior" in its last 
stage, with this exception, that here we also observe symptoms 
similar to croup, and frequently there, where the course of this 
disease has been very rapid, or where the first two periods have 
been overlooked, the physician is called to a case of croup. 

From the foregoing it will be easy to distinguish diphtheria 
from two diseases resembling it. The one is Fegarite or Sto- 
macacl^ the other •Angina Scarlatinosa. But even a mistake 
here would be of little amount, since, in my opinion, all are of 
the same nature, and will bear nearly the same treatment. 

Treatment. — This subdivides into local and general. The 
object of the local treatment is a destruction of both the product, 
(so that during softening it cannot affect the contiguous parts,) 
as well as a partial, but very circumscribed, destruction of the 
secreting surface, thereby causing normal secretion. 

For local applications, I select, according to the progress of 
the disease, the following remedies : Sulphate of copper, nitrate 
of silver, undiluted acetic acid, nitric acid, either diluted or pure, 
using the weakest caustic in the lesser, the stronger in the severer 
forms or stages of this disease. Tbe frequency of their applica- 
VOL. XIX — 14 



210 Diphtheriiis or Diphtheria. 

tion depends npon the severity of the form, etc. As a general 
rule, I cauterize about once in twenty- four hours, but have the 
secreting surfaces washed several times in this period with a 
solution of alum in water and honey. There, where the cautery 
would be too slow, or where the pseudo-membrane threatens to 
dissolve, 1 remove it with a pair of forceps and afterwards cau- 
terize the secreting surfaces. Besides this, I produce external 
counter -irritation upon the affected parts, by the tincture of 
iodine. 

The general treatment^ during the first and second period, I 
open with an emetic^ consisting of a mixture of ipecacuanha, 
tart, emeticus, and syr. oF squills. Its object is less to produce 
emesis, than general effects upon the entire, in specific, the gangli- 
onic system. This I follow, persistently, with sulph. of quinine, 
iron and opium. Of the former I prescribe, according to age, 
doubling the number of years by two grains, /. z., for a child six 
years of age, 6x2=12 grains of quinine per twenty- four hours. 
When arrived at the age of fifteen years I cease doubling. With 
some exceptions the practitioner will find this a fair schedule. 
Of iron^ I prefer the muriated tincture. The quantity 1 leave to 
the option of the reader. Of opiums or rather its tincture, I 
give just enough to prevent the quinine causing diarrhoea. The 
entire I give in a solvent, /. «., pure water, and continue this 
prescription during the first two or three days. Afterwards I 
relax and give smaller doses, but do not discontinue this treat- 
ment until all fever has ceased. 

During the third Period^ instead of the muriated tincture of 
iron, I prefer the sulphate, and am.in the habit of giving to a grown 
person ( fifteen years of age), from 16 to 20 grains, and of the 
tinct. of opium from 19 to 57 drops (containing from one to 
three grains of opium) per twenty-four hours. 

Under this treatment, if the destructions are not too great, the 
colliquative diarrhoea will soon cease and the patient recover. 
In case the disease has made its progress into the larynx, threat- 
ening suffocation, tracheotomy ought to be performed without 
delay. As much as I do rely upon these remedies, I do quite as 
much depend upon a generous diet. Broths, vegetables, acid fruits, 
and generous wine, ought to be given to the patient, certainly not 
too much at a time, but by no means in stinted proportions. 



Osseous Anchylosis of the Knee-Joini, 211 

ARTICLE IV. 

Complete Osseous Anchylosis of the Knee-Joint. Barton^s 
Operation modified by Buck. Successful Result. By Ohas. 
A. PoPB, M.D., Prof, of Surgery* in the St. Louis Medical 
College. 

Messrs. Editors : Ab you request of me an article for your jour- 
nal, I have thought that a report of the following case might prove of 
interest to your readers, especially as this operation has as yet 
been performed in but a very limited number of cases. 

The patient, Mr. A., a saddler and harness maker by trade, 
aged forty, of good constitution, received, when about ten years 
old, an accidental gun-shot wound, the ball passing just below the 
right knee-joint. The articulation became secondarily involved, 
and its complete osseous anchylosis was the result. 

The limb was permanently flexed at near a right angle. For 
long years he had a worn a wooden peg, with the knee resting in 
a socket at its upper extremity, for purposes of locomotion, in 
walking, the foot and leg projected inconveniently backward, 
whilst in sitting the wooden appendage stuck out still more awk- 
wardly in front. So that in this, as in other respects, the an- 
noyance was so great, that he had been led to seek relief, if pos- 
sible, by an operation. The anchylosed limb was, as usual, 
smaller than its fellow. 

The nature and risk of the proposed operation having been 
fully explained to him, he expressed a decided wish and deter- 
mination to have it performed. 

As the patient preferred to be operated on at his own home, in 
Marine, Illinois, I consented to go over there for the purpose. 
Drs. Smith and Gregory of this city accompanied me, and to- 
gether with Dr. Jno. S. Dewey of Marine, assisted me in the 
operation, which was performed on the 14th of March. 

The patient being under the full effect of chloroform, I made a 
long semicircular incision through the integuments, commencing 
at the upper part of the internal condyle of the femur, sweeping 
round in front just above the superior edge of the unrecognizable 
patella, and terminating over the external condyle. This cap- 
shaped flap was carefully raised from the bone, and dissected well 



212 Osstious •^nchyloBis of the Knee^ Joint. 

back to the cunvenient distance of nearly five inches. A fine saw 
was now entered at the most prominent part of the bonj angle, 
the apex of the knee, and directed obliquely upward and back* 
ward toward the posterior surface of the femur a short distance 
above the condyles. A second section was then made with the 
saw, from the front of the femur, so as to fall on the first without 
entirely severing the continuity of the bone. A few posterior 
fibres were purposely left in order to prevent any danger to the 
popliteal vessels, and also to assist by their slight irregularity 
when broken, in the subsequent adjustment of the bones. The 
flat wedge-shaped piece of bone thus removed measured 4| 
inches long, 1^ inches thick, and 3^ inches at its broadest part. 
The angle removed was 9r, that being the complement of the 
angle of deformity. The limb was now laid on a double inclined 
plane, the angle of which could bo varied at will, by means of a 
screw. Having closed the wound by points of the interrupted 
suture, a moderate extension was made on the foot, which caused 
the rupture of the thin posterior portion of bone left undivided. 
The patient bore the operation well, having felt no pain. I then 
left him in the care of Dr. Jno. S. Dewey, a gentleman of high 
intelligence and professional worth, to whom I am indebted for 
the subsequent details of the case. 

March 15th. Mr. A. after the operation had no depression, 
and no reaction ; his pulse all night was 80 per minute. Gave 
him two doses of morphine four hours apart. This afternoon his 
pulse rose to 90. No pain, but some swelling and redress ; skin 
adhered wherever there is contact : blood oozes slowly from the 
wound. Extended the foot by means of a screw, which, for a few 
hours, produced slight spasmodic contractions of the muscles of 
the thigh. 

16th. Pulse 100; no pain; swelling very little increased; 
extended the foot an inch, with less muscular resistance. Has 
not missed a meal, nor an hour's sleep. Expresses the utmost 
confidence that all will go well. 

17th. Pulse 84 — rather small — has just had a discharge from 
his bowels. Gave him toddy, which increased the volume, but 
not the frequency of his pulse. Toddy continued every four or 
six hours. Wound is much as it was yesterday ; skin not quite 
so red ; the serum that oozes from the wound is nearly colorless ; 



Osseous Jinchyhsis of the Knee- Joint. 213 

no pain. Extended the foot one inch ; appetite good, sleep quiet. 
The patient is elated with his prospect — ^says he knew that he 
wonid do well. He is often raised up in bed to admire the pro- 
gress made in'4)ringing down his foot. 

18th. Pulse 88, with good Tolume — discharge from the wound 
is dark and tenacious — ^bowels move every day; sleep is quiet. 
Toddy discontinued. Foot extended until it is uncomfortable, 
every morning, when the system is most relaxed, and do not in- 
terfere with it again that day. 

21st. Did not rest well through the night; bowels not moved 
for thirty-six hours. Gave unusual distress in extending the 
foot, in the knee, and along the femur; pulse 100. Ordered a 
dose of castor oil, and a teaspoonful of sweet spirits of nitre, 
every two hours ; discharge from the wound light-colored, thin 
and increased in quantity. This afternoon patient is very rest- 
less ; pain along the femur and in hip-joint ; pulse 108, and small ; 
drew up the foot a very little with the screw. Gave J grain of 
morphine, and in an hour an enema. 

22d. Rested well; pulse 100 ; appetite good ; discharge from 
wound darker and more tenacious; the knee tender; did not ex- 
tend the foot ; bowels not moved. Ordered oil — discontinued the 
nitre. I fear the foot will not be brought down any further, 
without serious consequences. The knee is now raised but five 
inches above a straight line. 

23d. Bowels have been moved copiously; pulse 88, more 
volume ; no pain ; discharge dark, tenacious, less in quantity. 

24th. False same as yesterday ; no pain; the flow from the 
wound is again dark and thick ; appetite good ; sleep quiet ; very 
little swelling. 

80th. Pulse 88 ; matter lighter colored, the quantity proba- 
bly ! ij per day. 

April 1st, 2d, 3d. Patient about the same. 

4th. Discharge from wound less — agreed to leave leg in its 
present position, the bend being three inches from a straight line. 

6th, 6th, 7th. The same— scarcely any matter — patient sits 
in a chair and rests his foot on another; has had no pain of con- 
sequence ; has not lost a meal, but eats and sleeps like a har- 
vester. Takes occasionally of Edinburgh ale. The case now 
progressed well. 



214 St. Louis Medical Society Reports, 

In reply to my enquiries, some months after the operation, Dr. 
Dewey wrote me as follows : 

Dear Sir: You ask me the result of the operation which you 
performed on Mr. A's knee. It could not have been more satis- 
factory. I saw him a few days since, wheeling a hearily loaded 
wheelbarrow. He walks without a stick ordinarily, and .the angle 
at which his knee is anchylosed, is that which he himself chose, 
with the adnce of his friends. He says that no amount of money 
however great would induce him to have the leg back in its former 
position. 



ARTICLE V. 
PROCEEDINGS OF THE ST. LOUIS MEDICAL S0CIET7. 

BT 
THOS. EBNNABD, M.D., BBPORTINa 8E0RBTART. 

Dr. Kennard read an essay on Diphtheria, being part of a re- 
port made by the Committee on Diseases of Women and Children. 
He gave a succinct account of the history, nature, aotiology, 
pathology and diagnosis of the disease, together with the best 
modes of treatment. (See Journal for March.) 

Dr. Linton. In many particulars I fully concur with the views 
expressed in the paper just read before the Society, but cannot 
think Diphtheria a specific disease, nor see how the exudation 
characterizes it as such. I regard it rather as an epiphenomenon 
than as a separate and distinct disease, and believe the exudation 
is only one termination of inflammation, a mere result of disease. 
There are many cases where the disease does not go so far as for- 
mation of false membrane, and yet, in my opinion, are real gen- 
uine diphtheria — the same in essence as when the false membrane 
does form, only not quite so violent. It is merely a termination 
or result of several peculiar diseased conditions of the system. 
I have seen it combined with scarlatina, having a similar eruption 
as that disease and yet terminating with the exudation in the 
throat, and have known scarlet fever to terminate fatally without 
any eruption whatever. The two diseases seem to be very much 
alike at times and to be of a similar nature. Not long since I 
was called in consultation to see a case which the attending physi- 



Si. Louts Medicat Society Seporis. 215 

cian called cronp ; I thought and pronounced it scarlatina ; the 
patient's friends feared it might be diphtheria, and on examining 
the throat the exudation was there, and the case was really a com- 
bination of all three. There was the oroupj cough, the scarlatina 
eruption, and the diphtheretio exudation. So we cannot separate 
them and ought not to regard the name of the disease very much, 
but treat it according to its nature. To illustrate : in yellow fe- 
ver the skin is yellow and we have black vomit, but all cases of 
fever with yellow skin are not yellow fever, nor do all yellow fever 
patients have the black vomit. So all cases with exudation of 
false membrane on the fauces are not diphtheretio, nor do all .cases 
of true diphtheria have the false membrane. In regard to the 
treatment, 1 agree with the views in the essay, but have seen cases 
in which emeto- cathartics seemed to be the best remedies. I do 
not rely much on local applications, but never had any experience 
with turpentine as recommended, but suppose it would answer as 
well as any. 

Dr. Wm. Johnston. I cannot agree with Dr. Linton, but must 
consider diphtheria specific ; the false membrane, which is peculiar 
to it, distinguishing it from all other diseases. The London Lan- 
cet, during the past two years, has contained many valuable pa» 
pers and discussions upon this disease ; among others will be found 
a report from a special committee composed of some of the ablest 
men in England, and in that the diagnostic differences between 
this and kindred diseases are clearly pointed out. The committee 
state that scarlatina is a separate and specific disease, not the 
same as any other whatsoever, and of coarse we must logically 
conclude diphtheria differs from it ; so also with croup. Scarlatina 
poison seems to manifest its effects most plainly on the skin, 
whilst diphtheria affects chiefly the mucous membranes, and selects 
by preference the mucous membrane of the throat. Now there is 
evidently some peculiar, specific cause which determines the poi- 
sonous influence first to the mucous membrane, and by preference 
to the throat. According to the history of the disease, these pe- 
culiarities have characterized it from a time previous to the birth 
of Christ* We have no case on record of scarlet fever termina- 
ting in diphtheria, nor vice versa. Of course, cases vary greatly 
and need different treatment. I do not believe in the unity of 
disease as Dr. Linton seems to, but think certain poisons do pro- 



216 Si. Louis Medical Society Reports. 

duce peculiar diseases ; and when we find a marked symptom^ as 
the exudation in diphtheria, presenting itself ia every case, it 
ought to characterize it and entitle us to name it. The yellow fe- 
ver illustration will not apply, because yellowness of skin is not con- 
fined to that disease, while the peculiar exudation is to diphtheria- 
It is admitted that two distinct diseases may prevail in the system 
at the same time ; if so, I contend that they must be dependent 
upon specific and separate causes. 

Dr. Newman. I agree with the ideas expressed in the report, 
and think diphtheria is truly specific and different from scarlatina, 
croup, or any other disease. These diseases may supervene 
upon each other and be complicated, but are not one and the same. 
The high fever, hot skin and quick pulse of scarlet fever do not 
characterize this disease. It is impossible to find a name which 
precisely indicates every case of any disease ; but I think the 
name diphtheria a most appropriate one, representing as it does 
the most universal and characteristic symptom or effect of the dis- 
ease, the exudation on the mucous membrane ; which, however, is 
not a constant accompaniment, as, I believe, with Dr. Linton, some 
cases do not go so far as formation of false membrane. 

Dr. Newman said he dissented from the views suggested by Dr. 
Linton, both in regard to the essential character and treatment of 
Diptheria, but he desired especially to enter his protest against 
the treatment as suggested by the doctor. Dr. Linton's position 
in the profession was such that the bare announcement of his 
views would be regarded by many as. authoritative. Dr. L. had 
said that this disease was similar in nature to croup, scarlatina, 
&c., and amenable to similar treatment, as calomel, emetics, &c. 
Dr. N. was satisfied, from all the cases which had come under his 
observation, that, if this treatment were followed out, the disease 
would be much more fatal than it is. In diphtheria the vital pow- 
ers are depressed at a very early period, suggesting a sustaining 
and stimulating treatment; whereas in croup the opposite is true, 
and no treatment is so efficient as calomel, emetic tartar, &c., as 
suggested by Dr. L. 

Dr. Coons agreed with what he had heard of the report, 
and thought diphtheria was really a specific disease. All acknowl- 
edge, that a peculiar disease, different from any other known to us, 
and presenting this formation of false membrane as an almost con- 



Si. Louis Medical Society Reports. 217 

atant symptom, has prevailed to a great extent in this country and 
Europe during the past five years. It has, during the same pe- 
riod, been observed, that scarlatina, rubeola and kindred diseases 
have manifested a greater tendency to formation of exudation 
upon the mucous membranes ; but why this tendency does show it- 
self we cannot say. After the epidemic of cholera, which proved 
so fatal here years ago, almost every disease seemed to affect the 
bowels, just as now we observe the tendency to throat affections. 
I think diphtheritis is a more characteristic name than diphtheria, 
designating as it does the inflammation of the parts. 

Dr. Montrosb A. Fallen said, some microscopists think the 
exudation not a false membrane at all as in croup, but a true ne- 
crosis of the mucous membrane. 

Dr. Eenkard said, he still saw no reason why diphtheria was not 
a specific disease, and thought there was no necessity of confound- 
ing it with either scarlatina, measles, or croup ; for the symptoms 
and course were very diffierent, though similar in some respects. 
The course of progress and decline of scarlatina was marked and 
always the same. Not so with diphtheria ; the skin was hot and 
dry, the fever burning in the former disease, the reverse in the lat- 
ter. The eruption was an almost universal accompaniment of scarlet 
fever, but a rare exception in diphtheria ; the exudation in the lat- 
ter disease was false membrane, in the former no such thing ; in 
the one, ulceration beneath the exudation occurred — ^in the other 
there was no sloughing, nothing but a bright shining membrane 
was seen beneath. In the treatment of one, anti phlogistics were 
necessary ; in the other, very rarely to be employed, stimulants 
being the remedies. Group also required antiphlogistics and was 
confined much more strictly to young children, and there was far 
less chance of recovery from it. He said no case was true diph- 
theria where no exudation could be seen, as that was the charac- 
teristic or designating symptom. Location had no influence, or but 
very little, upon it, as shown in the paper read. He thought it 
much better to have a separate name for it, than to call it a mere 
termination of a variety of diseases, as Dr. Linton seemed to 
consider it. 

Dr. Johnston related the history of two well marked cases of 
diphtheria which he had recently treated. They were bad cases and 
both had recovered. He employed first emeto-cathartics, and then 



218 Si. Louts Medical Society Reports* 

administered small doses of iodide of potassium and qninine, and 
in one case used chloride of sodium and vinegar as a local applica- 
tion. He could not say whether their recovery was caused by the 
remedies used or not, but he had great reliance upon iodide of 
potassium and quinine. 

Dr. Hodgbn. After the operations of Tracheotomy that I have 
performed for the relief of throat affections, that must have ter- 
minated fatally by suffocation without it, I have been much 
troubled in keeping the tube free. In my last two cases I have 
used an instrument made of tinned wire, on the principle oE the 
spring speculum for the eye, and succeeded with this instrument 
in maintaining the opening free. The instrument is more easily 
introduced than the trachea tube, and does not demand that a 
portion of the trachea should be removed, as is necessary when hooks 
are used to keep the soft parts out of the way. 

I wish also to call the attention of the society to another instru- 
ment of my own. This instrument is intended to be. passed into 
the larnynx, between the vocal cords, with the blades closed, and 
when they (the blades) are opened sufficient space will be left be- 
tween them to allow the expulsion of any foreign b^dy that may 
have been accidentally introduced into the air passages. The in- 
strument consists, as you see, of two blades with their flattened 
extremities half an inch wide, (having a curvature of one- fourth 
of a circle, whose diameter is four inches,) hinged one upon the 
other five inches from the point, and having handles five inches in 
length. In using this instrument the index finger of the left hand 
may be used as a guide, and as the vocal cords are elastic, the in- 
strument may easily pass between them ; this operation being ob- 
viously less difficult since we know that the epiglottis does not, at 
any time, close over and cover up the laryngeal fissure. 

He thought the forceps could be introduced more easily than the 
probang, and, if so, the vocal cords could be dilated sufficiently to 
allow the escape of a moderate sized foreign body, simply by 
opening the handles. He had invented the instrument with the 
hope that it might supersede, in such cases, the necessity for 
tracheotomy, but, as yet, had had no chance to try it. 

Dr. PopB said Marshall Hall exhibited to this society an instru- 
ment of his invention, very similar to the wire speculum shown by 
Dr. Hodgen, and he himself had had one very like it, but it would 



SI. Louis Medical Society Reports. 219 

not answer the purpose. The best mode of procedure was to 
fasten back the flaps, made by the incision, by means of small 
books, and then cat out a small portion of the trachea, thus mak- 
ing a permanent opening, one which could be kept free as long as 
necessary. 

THS LABYNaOSGOPB — ^ITS IMPORTANCE IN THB DIAGNOSIS OF DIS- 
BA8BS OF THB THROAT. 

Dr. MoNTROSB A. Pallbn called the attention of the society 
to the use of the laryngoscope, as improved by Czermak, of Pesth. 
This instrument is intended and well adapted for aiding in the 
physical diagnosis of diseases of the throat. As now employed 
by Czermaky it consists of a circular mirror with a round opening 
in the centre, similar but of greater diameter than that of the 
opthalmoscope, with a small reflecting mirror, mounted on a stem 
and arranged at an angle of about 45^, and, with my improve- 
ment, the handles attached at right angles to the horizontal shaft, 
so that the reflecting mirror can be held in the pharynx whilst the 
hand of the operator is at the side of the face. Either sun or ar- 
tificial light can be employed, and, with a strong light, the mirror 
will illuminate the whole pharynx. Then the small mirror, heated 
to the temperature of the mouth (to prevent condensation of the 
breath) can be gently introduced and placed against the velum 
palati and uvula. He had used the reflector of Desmarres' 
opthalmoscope to reflect the light either from sun or gas light. 
By means of this instrument, properly used, we can make a thor- 
ough exploration of the pharynx, larynx and upper portions of 
the trachea, and Csermak says he has seen the rings of the trachea 
and bifurcation of the bronchial tubes ; but I have never seen so 
far. On elevating the epiglottis by expiring we can see the interior 
of the glottis, with its vocal cords, and we may easily view the 
whole of the larynx. We must remember in making our exami- 
nations that everything is seen reversed, by action of the reflect- 
ing mirrors. We will find our examinations give rather negative 
results, and frequently but very little organic change is seen in 
grave disorders of the throat; e. g., in chronic hoarseness, we 
sometimes see little or no structural change; in one of long 
standing, I found nothing but slight oedema of one vocal cord ; 
in another case of aphonia, there was found on each vocal cord a 



220 St. Lonis Medical Socieii/ Reports. 

very small diaphanoas or translucent tumor; in phthisis laryn- 
gitis, I have not detected any tubercles. In another cla»s oE sore 
throat, which I propose to call glu co-laryngitis, because it arises 
from a stomach deranged by too free use of sweets, we find no 
disease below the pharynx and edge of the oesophagus. 1 have 
now used this instrument in quite a number of cases and think it 
an invaluable aid. It requires practice and delicacy of touch to 
be able to introduce this instrument without exciting an effort to 
eject it, but almost any throat can be schooled to its use. 

GONORRHCEA. 

Dr. Kennard said the subject of gonorrhoea, its nature and 
treatment, had been proposed for discussion two meetings ago, 
and, as nothing was of more interest to the profession, he 
would like to hear if any of the members had tried the treatment 
of this disease by alkalies, as recommended by VVeeden Cook of 
London, who says that the treatment by balsams, which is always 
offensive, is rarely necessary, and that his mode of treatment by 
rigid diet, alkaline carbonates, and weak injections of sulphate or 
chloride of zinc, would prove successful, in almost every case, in a 
very short time. He recommends acetate of potash, one and two 
drachms daily, in divided doses, and in more obstinate cases com- 
bines chlorate of potash with the acetate. Dr. K. had used this 
treatment in five or six cases and with eminent success, and no in- 
convenience to the patient. One of our army surgeons had rec- 
ommended simple injections of chlorate of potash frequently 
repeated. The rationale of the alkaline treatment is that we 
thus correct the acidity of the urine, which, in passing over the 
inflamed mucous membrane of the urethra, is one of the princi- 
pal causes of pain in micturition, and tend3 to keep up the in- 
flammation. The plan was certainly much more agreeable to the 
patient than any other yet proposed, and so far seemed more sat- 
isfactory to the surgeon. 

Dr. Wm. Johnston thought we could find no disease more 
troublesome to treat than gonorrhoea, particularly the chronic cases, 
and, as yet, he knew of no very satisfactory method of curing it. 
In the winter of 1836 he heard Dr. Dudley of Kentucky say 
that this was a specific disease, caused by a specific virus, running 
a specific course, and no remedies we yet knew of would shorten 



St. Louis Medical Society Reports, 221 

its duration, and, for himself, be rarely used any but hygienic 
measures. We all now believe that this great man was entirely 
wrong, for various modes of treatment do cut the disease short 
and care it ; still we do not fully understand its nature and mode 
of propagation. We read that about the year 1191, in Naples, 
ill Rome, in Spain, and elsewhere, both forms of venereal disease 
appeared, and in many cases the syphilitic ulcers were so violent 
and destructive, that the disease was thought both infectious and 
contagious ; now we know it requires actual contact to produce it. 
We also know that leucorrho&a and other non- virulent discharges 
will produce the disease ; but how it is propagated when once com- 
municated, we do not so well understand. I think it must be by 
the so-called law of fermentation, that the pus, when once applied 
to a part, extends itself along the urethral canal. Some English 
physicians are now contending for this theory, and I think it the 
most satisfactory explanation. The treatment recommended by 
Cook is an old one* How do the injections of chloride of zinc 
act ? by causing a new inflammation and thus curing the existing one, 
or by acting chemically as an antidote to the gonorrhoeal pus ? 
I imagine it must be by changing the nature of the inflammation. 
Dr. Eennard. If we undertake to argue the origin of vene- 
real disease we would never come to any truthful conclusion. I 
do not believe that it originated in the New World and was im- 
ported into the old for the first time in 1494, as many have con- 
tended, but believe the disease has existed almost ever since the 
creation of man, and has been the same in nature for thousands 
of years that we find'it to- day. Gonorrhoea is the same now that 
it ever has been ; but ignorance, superstition and false modesty no 
longer prevent us from seeing and studying it in a scientific and 
accurate manner. Thirty years ago, our ideas about the origin and 
pathology of the various venereal diseases were confused and un- 
satisfactory. Hunter, whose views were then the most generally 
accepted, believed the source of gonorrhoea and syphilis were the 
same and identical, and that they differed only in form, accord- 
ing to individual peculiarities and intensity of the poison. Ben- 
jamin Bell, in 1793, opposed the idea of identity and contended 
they were not the same at all, and showed that veneral pus would 
not produce gonorhoea. Occasionally, however, secondary syph- 
ilis seemed to follow simple cases of gonorrhoea, and this puzzled 



222 St. Louif Medical Society Reports. 

the opposers of Hunter. Bicord, in 1880, commenced his exam- 
inations of the subject in Paris, and, in using the speculum in fe* 
males, soon found that what some thought simple gonorrhceal dis- 
charge, really came from a chancre high up in the vagina or even 
on the neck of the womb, and that balanitis was often due to a 
chancre under a long prepuce. After extensive and accurate ex- 
perimentation, he determined conclusively, that pus from a non- 
ulcerated mucous surface would not produce chancre, and vice 
versa. Again he proved that simple gonorrhcsa was not necessa- 
rily produced by a specific virus, but that a discharge from a 
mucous membrane could be caused by almost any irritant, and 
that the acrid. vaginal discharges from women not diseased, from 
those having leucorrhoea, or their catamenial flow, would produce 
gonorrhoDa in many instances. He proved that the majority of 
cases of gonorrhoea were benign, and when virulent we could al- 
ways discover a concealed chancre ; and also, that although the 
disease most generally attacked the genito- urinary organs, it would 
also disease any mucous membrane, and produce gonorrh<Bal op- 
thalmia, &c. He showed also that balsam acted locally in curing 
this disease, changing or soothing the inflammation by passing over 
the mucous membrane of the urethra, after passing through the 
blood and in the act of being excreted in the urine. They exert no 
beneficial effect in females, in males suffering from hypospadias, 
ingonorrhoeal opthalmia, or by being injected pure into the vagina 
of females. 

The abortive treatment by injections of nitrate of silver, vary- 
ing from 10 to 40 grains to an ounce of water, at one time quite 
common and highly recommended, has proven dangerous and un- 
certain, producing sometimes ulceration of the urethral canal, 
abscess of the perinseum, inflammation of the bladder, and other 
complications. It is much safer and more satisfactory, where the 
patient desires a rapid cure, and applies before violent inflamma- 
tion, pain and discharge has set in, and is willing to keep in bed 
for a day or two, to employ, as abortive treatment, injections of 
five grains of nitrate of silver to the ounce of water, thrown well 
into the urethra by a long nozzle syringe, and retained there for 
four or five minutes ; and if this does not cause much pain or an- 
swer its purpose, we must use a stronger solution of eight or ten 
grains to an ounce of water. Afterwards confine the patient, give 



St. Louis Medical Society Reports. 228 

• 
a good catbartio, so as to produce free action of the bowels ; di- 
rect total abstinence from food, and frequent bathing of the penis 
in water as warm as it can be borne; and as the pain and discharge 
subside, nse weak injections of sulphate of zinc, one or two grains 
to the ounce. A cure may this way be effected in a few days. 

When we do not employ the so-called abortive plan, I much pre- 
fer the alkaline treatment (from a limited experience) to that by 
balsams. So far I have relieved my patients in a.short time, and 
certainly in a much more agreeable manner than by the usual 
methods. Of course we cannot cure all cases thus ; sometimes 
we will need balsams, and often tonics. 

Dr. PoPB. I think but little or no improvement, in the treat- 
ment of this disease, has been made during the last half century, 
and believe the best remedy is rest, absolute quiet, with diluent 
drinks, cathartics to keep the bowels rather open, and weak injec- 
tions of sulphate of zinc, which I prefer to all other injections ; 
the trouble is not to stop the discharge but to prevent its returning. 
In a vast majority of cases of chronic gonorrhoea, the discharge 
is kept up by commencing stricture, and no remedy is half so benefi - 
cial as the repeated introduction of the silver or polished steel 
bougie, three times a week, or every day, as the case may require. 
In many of these cases, the mental influence is the worst to coun* 
teract. The worst case I overbad to treat was that of a preacher 
— which was really no case at all ; but the man had sinned, and 
was convinced that he had. it whether or no. Not long since, a 
gentlemen anxious to be married, came to me from a long distance 
simply to get my certificate that he bad no disease, as his rival had 
reported to the lady's family that he had, and the marriage could 
not coine off until that was fixed. He had no disease at all, and 
I gave him a certificate to that effect. As regards the alkaline 
treatment^ I have used the liquor potasee for a longtime, and found 
benefit from it. The disease extends itself in the urethral canal, 
and on other mucous membranes, simply by means of contiguity 
of tissue. 

Dr. Ebnnard asked if Dr. Pope did not think gleet was often 
oonfoanded with what Professor Gross denominates prostatorrhoea, 
a discharge from the prostato gland. 

Dr. Pope had no doubt it frequently was. It may be caused 
by the disease of the prostate, by stricture, and by continued irri • 



S24 Si. Louis Medical Sociely Eeporls. 

tation of the membranoiis portions of the urethra. We must not 
leave off our remedies as soon as the discharge stops ; for if we do 
pot continue them for a while, it is apt to return. 

Dr. McPhebtbbs. In the pathology of gleet, the location of the 
disease has ordinarily been confined to the membranous portion of 
the urethra. This view is entertained by most surgeons. Re- 
cently I noticed in one of the foreign journals, that a writer op- 
poses the generally received idea, and says it is really a disease of 
the glans penis, and acting upon this belief he introduces elastic 
bougies, smeared with mercurial ointment, into the glans, and then 
by pressing it as he withdraws the bougie, leaves the ointment in the 
urethra. He reports a large number of oases successfully treated 
in this way. With regard to the treatment of gonorrhoea, I pre- 
fer rest, dieting, diluent drinks, and weak injections. The acetate 
of potash, it is well known, is one of our most reliable diuretics, 
and may do more good by increasing the quantity and thus dilut- 
ing the urine, than by any peculiar benefit it has in correcting the 
acidity of the urine. 

Dr. M. A. Pallbn related a case of 

POISONINa BY ATROPINE — ITS RECOVERY — ^WITH SOME REMARKS ON 
THE DELETERIOUS BFI'BCTS OP BELLADONNA. 

Some two months since I had occasion to prescribe as a collyrium, 
an instillation of a solution of the Neutral Sulphate of Atropine, 
Ihree grains lo the ovnce of water ^ for an old gentleman, aged 
61, who was suffering from ulceration of the cornea and chronic 
iritis, the result of granular lids. As usual in such cases, a 
tonic plan of treatment was indicated, and is the course of time 
a solution of quinine ordered. 

On Monday last, the patient in question, through mistake, took 
a teaspoonful of the collyrium instead of the solution of quinine. 
Feeling an unpleasant constriction of the throat in a few minutes 
afterwards, he went to the apothecary from whom he had obtained 
the medicine, and learning its nature, obtained an emetic of ipe- 
cac, which he took when he reached home, which was about an hour 
after the medicine was taken. Rapidly growing worse, medical 
assistance was sought, and Dr. M. M. Palten, fortunately being 
near, immediately saw him. 

Mustard and warm water was freely administered to him, 
through which profuse emesis was rapidly obtained. The symp- 



Si. Loui3 Medical Society Reports. 225 

toms, nevertheless, increased in violence) so that in a few minutes 
he became blind, the pupils being very much dilated. He com- 
plained very much of the constriction of the throat, with intense dry. 
ness and tingling of the fauces, and, in attempting to drink a glass 
of water, it was discovered that deglutition was impossible. He then 
became delirious, which continued for about three hours, when he 
slowly got better, and in about six hours more was pronounced out 
of danger. During the period of delirium the pulse was feeble, 
respiration difficult, great nausea and extremities cold. Stimu- 
lants were administered, sinapisms applied, and the surface of the 
body rapidly rubbed with coarse towels and salt. He has been 
quite feeble since, and the pupils are still dilated, but are slowly 
contracting to their normal pize. The peculiarity of the case in- 
dicates the amount of belladonna which may be taken without 
producing death, for in this instauce three-eighths of a grain of 
atropine was swallowed, and produced symptoms of an alarming 
nature, which, possibly, might have produced death, had he not 
received medical assistance so promptly. The usual dose of atro- 
pine when taken internally averages from ji^ to ^V of a grain, 
for according to Bouchardat f^ of a grain may produce all the 
deleterious symptoms above described. The recognized official 
doses of belladonna are 1 grain of the powder, } grain of the non- 
clarified extract, 1 grain oE the aqueous extract in pills, and i 
grain in the alcoholic and etherial tinctures. From these tables 
it would appear that the average increase in strength of atropine 
over belladonna is about 40, and that three-eighths of a grain of 
the former is equal to 15 grains of the latter in powder. 

Belladonna is an indigenous plant, growing along the shady sides 
of old walls, and flourishes during the months of June, July and 
August ; it bears a dark berry similar to the black cherry, although 
rather smaller, and for which young children might readily mis- 
take it. It is very poisonous in all of its parts, and belongs to 
the genus monopetal dicotyledons known as the Solanea, and, ac- 
cording to Brandes, is composed of 

Malate acid of atropine, . • . . 1.51 

Gum, 8.38 

Starch, 1.25 

Resinous chlorophyl, 5.84 

Ligneous matter, 13.7 

Of salts, and an analogous matter to osmazone, 9.87 
Vol. ^tx— 15 



226 Si. Louis Medical Socieiy Reports^ 

I do not propose to extend my remarks upon the therapeutical 
effects of belladonna, bat to confine myself as briefly as possible 
to the physiological manifestations as indicated by an overdose. 
From the earliest times this plant has been recognized as a poison, 
for we find in the works of Pliny the following, *' Hie niger est, 
hinc ta Romane, caveto;" and he goes on to elaborate the yarioos 
yiralence of the root, berry and leaves m the order mentioned. 
His observations have since been confirmed by Orfila and Panquy, 
who found more of the supermalate of atropine in the expressed 
juice of the roots than in any other part, and that two grains of 
the extract would produce the most sinister results. Before con- 
sidering the poisonous effects of belladonna upon man, it might not 
be deemed amiss to notice some of its results upon animals. 
Thus, a rabbit, according to Trousseau, was fed upon belladonna 
leaves for more than a week without manifesting the slightest in- 
convenience, not even dilation of the pupils. Orfila caused a 
small dog to swallow thirty of the berries without producing any 
effect. Other dogs, however, rapidly died, with all the symptoms 
of narcotic poisoning, under the influence of the aqueous extract ; 
in these cases great dilation of the pupils was observable. When 
injected in the veins or applied to the cellular tissue, the poisoning 
was very rapid and intense. When poisoned by means of stom- 
achic absorption, this viscus presented no marked inflammatory 
symptoms, and in only one of four post mortem examinations 
was any appreciable lesion manifest, and in that one four small 
round ulcers were found. Flourens experimented largely upon 
birds with belladonna, and noticed that the tubercula quadrigemina 
were specially affected, that the cranium immediately above them 
was red from blood infiltration of the diploe, and that during life 
the birds were totally blind, being unaffected by the appearance of 
any object however brilliant. 

With atropine, according to Reisinger, one grain administered 
to a dog produced some symptoms of slight narcotism and a 
Slight dilation of the pupil, from which it recovered in about two 
hours ; whilst with one grain of the extract of belladonna, the same 
symptoms were brought about in the same length of time and took 
about three hours to wear off. What is more singular still, that 
upon young rabbits, according to Reisinger, the same doses of atro- 
pine and hyosciamus produced not the slightest effect. 



St. Louts Medical Society Reports. 227 

With regard to the human species, there seems not to be the 
Same protective influence against the poisonous action oF the 
drug. Thus Bulliard makes mention of fourteen children who 
poisoned themselves by eating of belladonna berries in the garden 
of the King of France in 1773, and Ganther de Claubry speaks of 
ono hundred and fifty soldiers who were guilty of the same mistake, 
many of whom succumbed under the deleterious influence of the 
drug. A remarkable peculiarity in the action of belladonna is 
the fact of its special inclination to the automatic system of 
nerves; and stranger still, when absorbed by the stomach and 
dilation of the pupil is produced according to Eklers, there is some 
functional derangement of vision even to blindness ; but when in- 
stilled in the eye, or inuncted peri-orbitally, no such functional in- 
terference takes place. Brandes, however states, to have observed 
from the vapor of atropine or its salts, dilation of the pupil, 
nausea, pains in the back and vertigo ; and he himself experi- 
enced the same feelings from having tasted simply of a small quan- 
tity, which he found more salty than bitter. Among the numerous 
well attested cases of poisoning by belladonna but very few were 
fatal, and Gigault, a surgeon at Pont-Croix, department of Fin- 
istre, France, in a communication to the Academy of Medicine, 
states, that among many hundred such cases, in an extended prac- 
tice of over than 30 years, he never had witnessed a death. 

The usual symptoms attending a belladonna poisoning are 
nausea (not always followed by emesis), dryness of the mouth, 
constriction of the throat, headache, vertigo, fainting, lipothymia 
and extreme dilation of the pupils attended with functional de- 
rangement of vision, and generally complete blindness ; also red- 
ness and tumefaction of the face, the conjunctiva injected and 
red, the stare fixed, sometimes dull, haggard and deadened, some- 
times furious and maniacal. Hallucinations follow on, attended 
with slight delirium, which increases in intensity, generally of a 
gay character analogous to the condition produced by the inhala- 
tion of the protoxide of nitrogen (laughing gas), marked by the 
most grotesque of extravagances, gesticulations and immoderate 
laughter, or an irrepressible desire for loquaciousness. Aphonia 
sometimes ensues, as Claubry andFranck both enumerate cases of 
such. Rarely the delirium is of a sombre, or stupid, or comatose 
character ; some of the soldiers above mentioned, however, 



228 Si. Louis Medical Society Reports. 

affected such, but the majority were foolish and frivolons in the 
extreme. Sarlandiere relates a case of complete somnambulism 
being induced in the case of a tailor, who stitched at airj and 
formless coats for more than twentj-four hours, and held imagi- 
nary conversations with suppositious nobodies. Boucher, Murray 
and others mention cases wherein the delirium was of the most 
fearful character, and terminated in partial and general convul- 
sions, and tetanic rigidity. Munniks relates a case of well marked 
tetanus produced by the poison, accompanied with rigidity of the 
muscles of the jaws, face and neck, and winding up with opisthoto- 
nos. Sage relates a case wherein coma existed for thirty hours. Par- 
alysis of the bladder is a frequent symptom, together with an in- 
voluntary desire to urinate and defecate. Sometimes, instead of 
the excrement and urine being voided, a discharge of blood en- 
sued ; the genitals are handled by the patient, who, if it be a fe- 
male, sometimes manifests nympho-mania, and, if a male, constant 
erection of the penis. The skin frequently presents a scarlatin- 
ous redness, and apthous eruptions are found all over the buccal 
cavity. The pulse manifests various dispositions, sometimes fee- 
ble and frequent, then slow and weak, and again full and strong. 
The delirium is sometimes non-sanguineous, sometimes inflamma- 
tory, attended with hurried respiration, great heat of head, tu- 
multuous action of the heart. Sometimes the respiration is ster- 
torous and phyxioid. There may be great roughness of voice 
and complete hoarseness. Koestler of Vienna mentions several 
cases where there existed a croupy cough. Constipation of the 
bowels and meteorism are frequent. 

In the few cases where post mortem examinations have been 
held, the paucity of the results is to be regretted. In a case re- 
ported by Faber there was nothing appreciable save a lividity of 
the tissue of the heart, an absence of fluid in the pericardium, 
and a few spots of a gangrenous character in the stomach. In a 
case reported by Zmclin, of a shepherd who died comatose, there 
was an engorgement of the vessels of the head, and the blood was 
in a fluid state, and flowed freely from the eyes anoi nose. From 
the above we are led to believe that belladonna has a special ten- 
dency to the brain and nervous system of a peculiar character^ 
and operates in an apparently hyper- physical manner, in a direct 
ratio as to the development of nerve tissue. 



Remarks on Dysentery, 229 

In regard to the treatment of poisoning by belladonna the usual 
rules hold good, viz., emptying of the stomach and intestinal ca- 
nal, counter-irritation, sinapisms, warm and cold baths alter- 
nately, bleeding if there be much exaggerated action of the heart 
and great heat of head with violent delirium, and stimulants if the 
condition of the system should so indicate. Coffee has been in- 
dicated, and it seems to me, reasoning synthetically, that opium and 
belladonna might be considered antidotes, as an over- dose of the 
former always produces contraction of the pupils, whereas the lat- 
ter always produces great dilatation. 

In a medico- legal point of view we have as yet not discovered 
any appreciable cause, so as positively to indicate poisoning by 
belladonna ; although Runge of Berlin states that belladonna, 
henbane, and stramonium, are the only substances which, when 
applied to the eye of a cat, produce dilatation of the pupil. This 
peculiarity is manifest even when mixed with the aliment, the ex- 
crement, the urine, the bile, or the blood ; and that, when dissolved 
in water and applied to a cat's conjunctiva, dilatation of the pupil 
will take place. Having arrived at this conclusion, we can only 
have reached a mere probability, and in giving testimony on such 
a subject great care should be taken lest in a too rapidly drawn 
conclusion we might consign a fellow mortal to a felon's doom, 
when perhaps he may be as innocent of crime as the purest of 
mortals. 



ARTICLE VI . 
For the St. Louis Medical and Surgical Journal. 

Columbia, Ills., April 8th, 1861. 

Dogmatic assertion, come flrom whom it may, is not proof! 

In the March number of this journal, there appears an article 
on Epidemic Dysentery ; on this subject I beg leave to ofiFer a 
few remarks, and submit them to those who have as good ^^a right 
to speak" as MM. Trousseau or le nomm^ Pidoux. 

The treatment of uncomplicated dysentery with neutral salts 
is by no means a new theory or practice. By uncomplicated 
dysentery, I mean such an inflammatory state of the large in- 



230 Remarks on Dysentery. 

testines as is caused by exposure to oold or other cause, that ar- 
rests the capillary circulation, prevent the elimination and excre- 
tion of effete matter through the skin or by the proper emuncto- 
ries; quite a different thing from dysentery, complicated with 
malarial disease, requiring mercurials, anti-periodics — say, qui- 
nine, mineral acids, &c., for their cure. 

^^Opium," says the author of the article alluded to, ^'is one 
of the sovereign resources of the materia medica," (a fact, though 
intended as ridicule,) ^'and is perhaps the pharmaceutical sub- 
stance with which most harm may be effected ; it is in incessant 
use" (as it should be), ''and is strangely abused" (as it should 
not be), "being (in M. Pidoux's happy phrase!!) the knout of 
the therapeutist" (of the very scientific ones of course). **With it, 
(the knout, or the opium, or both?) every patient who complains 
or suffers is fustigated; in vain may you try the rational pro- 
cedures consecrated by usage, and in vain do you appeal to your 
intelligence and your experience ; all goes for nothing, pain is 
present, and the indication which dominates all others is to as- 
suage such pain, for which opium must be prescribed." 

Now, we do try the rational procedures of Sydenham, institu- 
ted more than two hundred years ago, and consecrated by the 
usage of tens of thousands of learned practitioners. We do ap- 
peal, and not in vain, to what little of intelligence we have, and 
to thirty- eight years' daily experience; and it goes for — some- 
thing ! ! it shows that opium, used and ''not abused," is the 
sheet anchor in the early stage of dysentery !! 

" A distribution of opiates (says the author) with easy com- 
pliance" (here our intelligence fails us) "is the mark of an 
impatient and ignorant practitioner ; it is a very convenient pro- 
cedure, and one to which every capacity is competent, which con- 
sists in drying up the intestinal canal by laudanum in a case of 
diarrhoea; and in roughly imposing silence upon the symptom 
pain in case of dysentery, accompanied with horrible tormina. I 
do not pretend to say that after having put into force the evacu- 
ant treatment, that we must never ^ when the patient is suffering 
cruelly, temper his pain by a few drops of laudanum ; but I en- 
tirely object to the practitioner at once drying up the intestinal 
canal ; for this is his aim in a case of diarrhoea, or dysentery ; 



Remarks on Dysentery. 281 

let him not meddle with opium , except with the most cautious re- 
serve,'' (lest he be * 'fustigated/') 

We see but little analogy in diarrhoea and dysentery ; — the first 
is attended with very little organic lesion in its early stage, a 
superabundant discharge of foecal matter and the pain chiefly con- 
fined to the small intestines, or often not attendant at all ; in the 
latter, the organic lesion is the effect produced, or the disease it- 
self from cause ; now, to remove this cause is really to cure, (it 
is the only way we ever cure anything ;) and how? I say, emphati- 
cally, with opium and Epsom salts. 

As long ago as 1822, large doses of opium, followed by 
Epsom salts, was pointed out to me by a very learned and expe- 
rienced man as the remedy for simple dysentery (we both at- 
taching the same meaning to the term simple). His rationale was 
about this : large doses of opium remove spasm, soothingly mod- 
erate and control hypersthenic vascular action, promote secretion, 
(the reason is very plain,) and consequently eliminate the ma- 
teries morbi ; the Epsom salts evacuate the small intestines of 
their irritating contents, before retained there by the spasm and 
thickened coats of the bowel below, and also promote absorption. 
His dose for an adult was two or more grains of opium, followed 
in an hour by nearly an ounce of the neutral salts ; the latter to 
be repeated in smaller doses, every two or three hours, until good 
f cecal evacuations are obtained ; these medicines were always 
followed by a free use of mucilaginous drinks, accompanied by 
a diaphoretic of Dover's powder. 

I do not believe in specifics, except in specific cases, quinine in 
intermittents, &c.; but I must add, that I have witnessed several 
epidemics of dysentery — treated many hundreds of cases, and 
when the case was appropriate, I have always found my mentor's 
prescription equally appropriate. The gentleman also observed, 
*' small doses of laudanum or opium do no good, but, on the con* 
trary, may occasion much harm : the spasm and inflammatory 
condition of the lower bowel unrelieved, the salts will not operate, 
and you lose valuable time." 

I would ask M. Trousseau, after having fully diagnosed his 
case of dysentery, why he wishes still to keep in view 'Hhe symp- 
tom pain?" Why, sir, pain kills people ; and if disease be an en- 
tity, pain is one of its accompanying urchins we wish to banish. 



232 Cases of Monstrosiiy. 

I used to think that ignorant practitioners left no ^^mark," and 
I now think that some learned ones leave marks not to be envied. 
The first named gentlemen, with all their learning, are surely igno- 
rant of the value oE opium and its correct application. S. 



ARTICLE VII. 
Cases of Monstrosity. By E. Montgomery, M.D. 

In the beginning of last summer, I was called upon to attend 
a lady in the northern part of the city ; on arriving at the resi- 
dence of the patient, I found her in labor with her first child, the 
uterus was well dilated and the membranes ruptured ; head pre- 
sentation, first position. In about an hour a large male child 
was born, with the most frightful physiognomy I had ever wit- 
nessed. The forehead was very low and narrow; the eyes very 
small and deep set; the nose a tremendous "pug" with very wide 
nostrils; the mouth was so hideous and unseemly as to baffle de- 
scription ; the upper lip was entirely wanting, and there seemed 
to be no gum or alveolar arch, but one palatine bone, extending 
towards the uvula in a slightly inclined plane; the tongue was 
very long and large and protruding from the right side of the 
mouth, and the lower lip everted so as to cover, almost entirely, 
the narrow chin. The low, narrow, sloping forehead, the angular 
face with its oval malformation, made the child look more like the 
offspring of an Australian aboriginal than the issue of Anglo- 
Saxon parents. The scrotum and testes were unduly developed, 
and the penis lay in a furrow formed between two folds of the 
scrotal integuments ; the glans, corpora cavernosa, and corpora 
spongiosa were well developed, but without a particle of prepuce 
or foreskin. The other members were all normal and well 
formed. 

When I made my visit the following day, I found the child 
dead; the mother informed me that it could not suck, or even 
swallow anything from a spoon ; that soon after I had left the 
preceding day, it began to have very noisy and laborious breath- 
ing, became livid, and died some fifteen hours after birth. She 
also informed me that when the was in her fifth month of gesta- 



Cases of Monstrosity. 283 

tion she had visited one of our suburban beer gardens, and in 
walking through the grounds she came suddenly and unexpectedly 
into close contact with a pet bear, which was chained to a large 
tree ; this startling appearance oF Bruin frightened her very much, 
and she had to keep her bed for two days, being threatened with 
abortion. 

On Sunday morning, the 24th of February last, I was hastily 
summoned to a case of .accouchement ; the messenger informed 
me that the patient was his wife, that she had been violently ill 
for the last ten hours under the care of a sage femme^ and, 
although the pains were strong and severe, there were no signs 
of a happy denoument. On my arrival, I found the lady in great 
agony, very impatient, and the midwife much alarmed. The lat- 
ter told me, confidentially^ that the child's elbows were present- 
ing ! and, on making an examination, I confess I did not know 
exactly how it was, as I could only feel two bony protuberances, 
with a soft gelatinous space between, and the pains were so pow- 
erfully expulsive that I could not extend my examination further 
in that direction. The patient told me this was her fourth preg- 
nancy, and that in her three previous confinements, she had easy, 
speedy, and natural deliveries. I again introduced my hand, 
and a strong expulsive pain coming on, the membranes were rup- 
tured, and a large acephalus monster female child was expelled. 
It was alive, and the large bright eyes glaring open, apparently 
on the top of its head, gave it a frightful appearance; but in a 
few moments those eyes became dim, the skin grew dark, and it 
was dead. Marshall Hall's ''Ready Method," the hot and cold 
douche, &c., was of no use, for there was no brain, and no breath; 
the cerebrum and cerebellum were both wanting, and the medulla 
oblongata was quite rudimentary, if not entirely absent. There 
was no skull, but a small portion of each temporal bone with the 
two mastoid processes very large and prominent : these were the 
presenting parts which puzzled me, and which were the cause of 
the midwife's belief that the case was a most extraordinary one — 
no less than an "elbow presentation !" A narrow strip of skin 
extended along above the nose and eyes, and a slightly concave 
space from this frontal margin to the atlas posteriorly, and from 
the mastoids latterly, contained nothing but a little gelatinous 
substance, resembling half coagulated bloody serum. Just below 



284 Cases of Monstrosity. 

the atlas, a hollow space (as if the spinous process and part oE 
the body of the vertebra had been scooped out) was filled with 
the same gelatinous matter ; two little round holes penetrated the 
face, about an inch apart, between which was a broad but very 
slightly elevated prominence, constituting the nasal appendage ; 
the mouth was small and round, and the chin and cheeks seemed 
continuous with the muscles and integuments of the chest ; — not 
the least appearance of neck — no line or furrow to denote where 
the facial surface ended, or the pectoral began. The body and 
extremities of the child were large and well formed, only that it 
was provided with a supernumerary finger to each hand. I have 
in one or two instances witnessed this peculiarity, but generally 
the redundant finger would be small, undeveloped, or sticking 
like a spur to the ulnar margin of the hand ; but in this case 
there were five fingers and a thumb to each hand, all well formed, 
of good size, and in natural positions. My not being allowed to 
make any dissection or post-mortem examination, will account 
for the incomplete and superficial description which is here sub- 
mitted : I regret this very much, but regret still more, that by 
no persuasion, or offer of any kind, could I induce the parents in 
either case to give me these specimens of abnormal developments 
for presentation to your museum. 

The mother of the acephalus child told me that she could think 
of no circumstance or casualty occurring to her during her preg- 
nancy which could probably influence the growth of the foetus, 
unless it could be great mental depression, heartfelt grief, and 
much tribulation from the loss of dear friends and relatives, 
worldly goods, &c. 

In most cases where these deformities are seen in infants of 
healthy and temperate (I mean temperate in all things) parents, 
I am inclined to attribute them to some strong and sudden mental 
emotion or nervous shock inflicted on the mother; but these specu- 
lations I will leave to medical philosophers and physiologists to 
elaborate. 



Case of Imperfar(Ue Anus, 235 



ARTICLE VIII. 

Case of Imperforate •Snusy reported by W. P. Beall^ M.D,^ of 
Coffeevilte^ Texas, 

Messrs. Editors : About the first of March, 1861, I was 
called to see a child, born a few hours previously, and was informed 
before my arrival, that the child had no anus. I found it a large 
boy, though it seemed quite indisposed, as it moaned and com- 
plained a good deal. It proved to be a perfect case of imper- 
forate anus. The place where the anus ought to be was firm, and 
no appearance or indication ol the bowel could be felt. The 
perineal seam or raphe continued nearly to the os coccygis. A 
small quantity oi a dark colored matter occasionally passed per 
urethra. With but a faint hope of saving the child, I deemed it 
my duty to advise an operation, which I did on the same evening. 
After placing it on its back, as for the operation of lithotcnny, I 
took a sharp bistoury and carefully cut to the depth of two and a 
quarter inches, when the meconium came away in considerable 
quantity. Before reaching that depth, however, I occasionally 
stopped to examine the condition of the parts being cut through. In 
a few minutes I discovered some blood passing through the urethra, 
which induced me to believe that there was a communication be- 
tween the bowel and bladder, or urethra. The incision was about 
three- fourths of an inch externally, and I kept a tent in the 
wound to prevent its adhesion. The meconium continued to pas s 
for three days^ (as well as the fecal matter, it having received 
nourishment frequently during its life,) at the expiration of which 
time it died. 

A post mortem examination revealed the communication be- 
tween the rectum and the prostatic portion of the uretha, which 
accounted for the passage of meconium and blood through the 
urethra. No other deformity existed in the case. The lower 
bowel and bladder, as well as the contiguous parts, exhibited signs 
of considerable inflammation. 

I record this case, not on account of the succeds, or the excel- 
lency of the operation, but on account of the rarity of the case. 
I believe there are but few, very feWy well authenticated cases of 
perfect recovery after the operation, especially when the distance 



286 Bibliographicdl Notices. 

to be cut is so great, or where a fistulous opening to the bladder 
or urethra exists. Had it not been for the opening, I think 
the child might have lived. 



PART II. 

REVIEWS AND BIBLIOGR APHS. 

ARTICLE I. 

•^ Practical Treatise on the JStiology^ Pathology^ and 
Treatment of the Congenital Malformations of the Rectum 
and Jlnits. By William Bodenhamer, M.D. Illustrated 
by ^ixteen plates^ and exemplijied by CCLXXXVII cases. JSTeto 
York ; Samuel S. Sr Wm. Wood. 

Until the appearance of this work all that has been written 
upon the congenital malformations of the rectum and anus has 
been inaccessible to the profession at large, except the slight 
notices in some of the systematic works on surgery. Most 9f 
the literature upon the subject has been scattered through the 
medical journals or published in reports to societies, which were 
read more for curiosity than information. To place before the 
profession all knowledge of value concerning the subject, and to 
correct the erroneous opinion enterfained by many, that an im- 
perforate anus is a lusus naturaSy unworthy of study and beyond 
remedy, the author has collected together and classified two hun- 
dred and eighty seven cases, as reported by various authors, and 
arranged them under nine difi'erent species according to the vari- 
ous shades of difference, and given the anatomy and pathology of 
each, together with the medical and surgical treatment, as sug- 
gested and improved upon, from the earliest times to the present 
day, with numerous lithographic illustrations, elucidating the 
same. Nothing definite has been, or probably ever will be, de- 
termined as to the cause of these malformations ; but the most 
natural supposition is, that mental influence or actual disease of 
the foetus in utero produces them. They present a great variety 



Bibliographical Notices, 287 

of forms, from the most simple and amenable to treatment to the 
most complex and unmanageable. 

The anus may be malformed bj preternatural narrowing ; by 
occlusion by a thin membrane ; by occlusion by a thick hard 
membrane; by partial or complete abseqce, and by abnormal 
anus. The congenital malformations of the rectum may be by 
occlusion of the rectum ; by obliteration of the rectum ; by pre- 
ternatural termination of the rectum ; by preternatural termina- 
tion of other organs in the rectum ; or by absence of the rectum, 
either partial or complete, as indicated by the author in his synop- 
sis. All of these varieties have been taken up seriatim, dis- 
cussed and exemplified by cases. 

In the last chapter, we have an account of artificial anus, giv- 
ing the various methods of performing the same. The author 
prefers making the perinseal opening whenever practicable, and 
says, the operation for artificial abdominal anus ought by no 
means to be resorted to until the surgeon has failed to find the 
end of the rectum through the perinseum ; for the abdominal 
anus is but a poor substitute for the perinatal artificial one. 
Other authors, as Tiingel and Amussat, recommend the opening 
through the abdomen when there is any uncertainty about the 
location of the rectum, and Tiingel thinks it the most rational 
operation for all cases of imperforate anus. Many of our ablest 
surgeons denounce the operation for congenital deformity of these 
parts as altogether unwarrantable, and think it inhuman to re- 
sort to an operation so dangerous, and even if successful, leav- 
ing the child an object of disgust and loathing, both to itself and 
its parents ; and although my feelings would make me hesitate in 
a case in which I was personally interested, I fully agree with 
the author, that it is the province of the parents, properly ad- 
vised by the surgeon, to determine whether the operation be per- 
formed or not. Our duty surely is to relieve suffering and pro* 
long life as far as practicable without regard to personal feeling. 
After giving the various modes of operating, the author expresses 
his preference for the method of M. Littr^, in all cases of chil- 
dren, as the most simple and easy of execation ; and although the 
peritoneum is opened, the danger of inflammation is not so great, 
nor can it be avoided by the modified operation of Gallisen, where 
the peritoneum is not cut. Littrd's operation makes the opening 



288 Bibliographical Notices. 

in the left iliac region, which the author thinks the most conve- 
nient and favorable when the perinaeum will not answer. 

It is only by dividing the labors of the profession that we can 
do much towards its advancement, and the author deserves much 
credit for the thorough investigation and elucidation of a subject 
hitherto so little studied and presenting so much of the disagree- 
able to the fastidious among us. Whether his book be generally 
read or not, he will have the satisfaction of producing the first 
complete work upon the subject, and connecting his name for all 
time to come with those who have not deemed it an unworthy task 
to relieve the little sufiFerers from the most distressing trouble 
which they are apt to fall heir to. K. 



ARTICLE II. 



•/9n Elementary Treatise on Human Anatomy. By Joseph 
Lbidy, M.D., Professor of Anatomy in the University of 
Pennsylvania; Curator of the Academy of J^atural Sci- 
ences; Member of the American Philosophical Society , 
and of the College of Physicians of Philadelphia^ SfC.j ^-c. 
With three hundred and ninety -two Illustrations. Phil- 
adelphia; J. B. Lippincott Sr Co. 1861. 

This new and elegant work by the distinguished American Anat- 
omist, Professor Leidy of Philadelphia, comes as near being an 
original treatise on this fundamental branch of medical science 
as any which has issued from the press for many a long day. It 
is admirably adapted as a text book for students, for which it 
was mainly designed by the author. Its appearance is unusually 
attractive. The paper on which it is printed and the typography 
are very superior, while the illustrations, which are numerous, are 
many of them new, and all of them elegantly executed. The 
descriptions are short and perspicuous, and with the aid of the 
engravings, which are to be found on almost every page, can 
readily be comprehended even by beginners. Another advantage 
is, that it is far less voluminous than most other modern works on 
anatomy, whilst at the same time it is sufSciently full for an 
elementary treatise. 



Bibliographical Notices. 289 

It has been the object of the author to simplify as much as 
possible the ponderous nomenclature of anatomy, by rejecting the 
numerous names, indiscriminately applied by different authors to 
the same part, and, in lieu thereof, selecting uniformly the same 
name, and always the simplest and most expressive for each part. 
And when admissible, he tells us, that the names have been angli- 
cised, and a copious list of synonyms added in foot notes. 

So far as the anglicising of the anatomical names is concerned, 
we are not prepared to say that it is an improvement ; on the con- 
trary, we believe that it is not, since the Latin and Greek terms 
(objectionable though many of them may be) are almost a part 
and parcel of anatomy, and as such are engrafted into the very 
mind of the profession. 

Altogether, Dr. Leidy's work is one of the best, perhaps the 
very best, text book on anatomy in the English language, and we 
therefore recommend it especially to students. 



ARTICLE III. 



A Treatise on Human Physiology: Designed for the use of 
Students and Practitioners of Medicine. John C. Dalton, 
Jr., M.D., Professor of Physiology and Microscopic Anat- 
omy in the College of Physicians and Surgeons of New 
York; Member of the New York Academy of Medicine; 
of the New York Pathological Society ^ SfC,^ Sfc. Second 
Edition revised and enlarged^ with two hundred and sev- 
enty-one Illustrations. Philadelphia: Blanchard Sf Lea^ 
pp. 690. 1861. 

Two years only have elapsed since the first edition of Dr. 
Dalton's work was off'ered to the profession. At that time the 
author was unknown to fame, but, in common with other medical 
periodicals throughout the country, we gave it a hearty welcome, 
accompanied by'^a deservedly favorable notice. Since then, how- 
ever, the work has received the almost unqualified approbation of 
the profession not only of this country, but also of Europe, and 
the author has been admitted to the rank of one of the first physi- 
ologists of the age. 



240 Diphtheria. 

Such being the recent history and well known character of the 
work ; all that is necessary at our hands at present is, simply to 
announce that a new revised and enlarged edition has been issued 
from the press of the well known Philadelphia publishing house 
of Blanchard k Lea. 

In the present edition, the author has endeavored to supply the 
deficiencies of the first, and has added a great deal of new matter, 
with some new and original illustrations from which the reader 
will be enabled fully to comprehend the actual condition of physi- 
ological science at the present time. 

It is unnecessary to give a detail of the additions ; suffice it to 
say, that they are numerous and important, and such as will ren- 
der the work still more valuable and acceptable to the profession 
as a learned and original treatise on this all-important branch of 
medicine. All that was said in commendation of the getting 
up of the first edition, and the superior style of the illustrations, 
apply with equal force to this. No better work on physiology 
can be placed in the hand of the student. To be had at Keith k 
Woods, r>th St, St. Louis. 



Diphtheria^ — ^Upon this subject, but little that is new or inter- 
esting is elicited. Dr. Prince says that the local application of 
the nitrate of silver has not met his expectations. '* A weak in- 
fusion of capsicum and a saturated solution of chlorate of potash, 
singly or in combination, have proved more satisfactory." Dr. 
Qoodbrake says^ ^' As a local application to the fauces and ton- 
sils, we found the mur. tr. iron to answer the best purpose in all 
cases that came under our treatment. We tried the nitrate of 
silver, sulph. of copper, alum and sulph. of copper combined ; 
but the tinct. of iron seemed to have the best effect in our hands. 

The beat remedies internally seemed to be quinine, tinct. of 
iron, chlorate of potassa, and good porter or brandy, with good 
nutritive diet,'' No allusion is made to a saturated solution of com- 
mon salt, as a wash or gargle to the throat ; this, of all means, 
has pleased us the best. We have applied this remedy to the 
throat for another trouble, which we may as well mention here as 
elsewhere, A lady of our acquaintance had, for many years, 
been subject to frequent attacks of quinsy, which always passed 
on to suppuration. In the last year, we have aborted two severe 
attacks by the local application of muriated tincture of iron, ap- 
plied several times a day. We have reduced the remedy with 
about two parts of water to one of tincture. 



Ckuiificatum qf Tumon. 241 

THE CLASSHriCAIXON, DUGNOSIS AKD PBOGNOSIS OF TUMORS, FROM 
A CHIBURGICO- CLINICAL POINT OF VIBW. BRIEFLY ARRANGED 
BT DR. THBOD.' BILLROTH. {Dcuische Kliniky 1859.) 
TraaalAted hj G Banmsarten, M.D. 

The division of tumors into those which do not recur after ex- 
tirpation, and those which recur and afterwards invade the general 
eystem, is, in this form, totally impracticable and untenable, be* 
cause it is contrary to observation. If we regard the faculty of 
recurring as an expression of the importance to the organism 
which the process producing a tumor possesses, and physicians 
cling with tenadty to this principle of division, it must be con- 
ceded that the above dualism does not exist in naturoj but that 
the categories, to correspond to observation, should be more nu- 
merous. When Walther, e. g., divided into scirrhus, carcinoma, 
and encephaloid, all that we are now accustomed to name carci- 
noma in the aggregate, he had certainly observed more accurately 
at the bedside than is usually done in later days. Formerly, only 
experienced surgeons wrote on such matters, — now every young 
microscopist, who has examined a few bits of tumor, feels justi- 
fied in talking on the most difficult questions in the doctrine of 
tumors ; the whole subject has been yielded too much to the his- 
tologists, and surgeons have retired, — partly, because they allow- 
ed themselves to be blinded by the powerful light the new intru- 
ders diffused around them. When I repeated in one of my first 
larger publications, ( Untersuch. ueber die Eniwickdung der 
BlutgtfmHse — Investigations on the development of blood- 
vessels — ]856,) the words of J. Mueller, ^^^e miscroscopical 
and chemical analysis (of tumors) shall therefore never become 
the means of clinical diagnosis ; it would be ridiculous to wish, 
or to suppose this possible" — I was repeatedly censured, pub* 
licly and privately, and reproached as mistaking the importance 
of pathological histology. I had appended to J. Mueller's sen- 
tence the foUowiDg remark : ^' It is my endeavor not only to gain 
for pathological histology an independent position and a purely 
anatomical ground, but also to re- install surgery, in regard to 
the diagnosis of tumors, in its full rights, which it had for a time 
but too willingly given up." Self-quotations, it is true, have 
Vol. XIX — 16 



242 CloMMificaiion of Tumors. 

lately come into great discredit, and I would not, though withoat 
fearing criticism, have repeated here my own words, if they did 
not in some respect represent the programme of my labors in this 
field. Until now I have published almost exclusirely my histo* 
logical observations, which necessarily* extended partly also to 
normal histology, since most of the general questions cannot be 
understood and worked out without comparing with pathological 
forms the normal types. That I do not disrespect pathological 
histology, as such, must indeed be credited, for else I would cer- 
tainly not have engaged in it so long ; even jiow I am constantly 
laboring, as far as is in my power, with new sources and new 
material, to investigate still further the most detailed views of the 
structure of pathological new- formations. But however worth 
knowing the results may be, because the exact cognition of a 
thing has always in itself a certain value and is productive of 
gratification to the investigator, they would, nevertheless, be be- 
yond the interests of physicians, almost as much as histology is 
beyond physiology. Just as the latter sciences are reunited only 
by the experimental method, so also pathological histology and 
clinical surgery only meet again in the observations at the bed- 
side. If this parallel was quite correct, we would be in unison 
with most observers, for all concede that the classification of 
pseudoplasms must not be left entirely to the hi^tologist, but that 
the latter must judge new- formations only with the aid of clinical 
observation, although with the histological structure for a basis ; 
but it is impossible to carry this through, since the above parallel 
is only partially proper. While for normal histology we can 
with some degree of consistency maintain the proposition, that 
like structure occasions like function^ — that, e. g"., we assume as 
certain the power of contracting wherever we find muscular ele- 
ments, — the same is not at all applicable to pathological tissues : 
tumors^ consisting of entirely similar tissues^ often have a 
very different clinical significance. This result of experience, 
which is becoming more and more valid, and which it was necessa- 
ry, at last, to acknowledge, since the decisive position taken by some 
pseudo-plasmatologists has led us now into this and now into 
that error, — makes the direct application of histological investi- 
gations to the clinical bearings of tumors perfectly unsafe, even 
if those investigations had ever so much experience for their 



Classification of Tumors. 248 

basis ; and this becomes still more remarkable and evident, when 
we consider that the examination of the intimate structure of 
some forms of tumors, especially the soft, depends altogether on 
the skill and experience of the individual. I will allude only to 
the fact, that by aid of the new methods of examination, of hard- 
ening tissues, etc., we can now gain in many tumors a precise 
insight into the disposition of the elements that formerly seemed 
only a chaos of cells, nuclei and molecules. 

Shall the physician in his diagnosis be dependent on such his- 
tological subtleties ? I answer emphatically, no. 

But even if we suppose that all difficulties of investigation 
would gradually be overcome, and histological information had 
progressed so far that every physician could form a complete ana- 
tomical diagnosis of tumors, — the fact, known by experience, that 
tumors with like forms of tissue can have a totally different clini- 
cal significance, would, nevertheless, make th&> availability of the 
most arduous investigations very doubtful. Without recurring 
to the embryon state of histology, which is still found in the 
modern views of the French, I will only mention that, after 
the specific cell- form was done away with, the areolar arrange- 
ment, for instance, was advanced as the characteristic of car- 
cinoma, so that consequently the enchondromata, which show 
this very areolar arrangement in the most exquisite manner, were 
to be counted among cancers, — which was right and was wrong, 
according to the individual cases. So also the ossifying tumors 
are of very various clinical importance according to their combi- 
nations and their seat, although they all contain osseous tissue. 
Of similar examples many more might be quoted. 

The most various ways have been followed to avoid these con- 
tradictions. Some believed, that the mode of development was 
the chief consideration ; this also has proved a fallacy : more re- 
cent investigations have shown that the origioating points of de* 
velopment of new- formations are nearly always the same, namely, 
the cells of the connective tissue. Then, they embraced the mode 
in which the new tissues were inserted into the old ; this furnished 
so far about the best foothold, but could likewise not be carried 
through consistently. While, in general, carcinomata are inti- 
mately connected with the mother- tissues, there are also some 
that are very accurately limited by a capsule {abgekapseii), e. g.^ 



244 Classification of Tumors. 

the majoritj of medollarj cancers. Still others abandoned more 
or less the idea of a thorough general classification, and contem- 
plated every histologically defined form of tunaor in regard to its 
occurrence in different organs and to the clinical experience we 
have on it. This plan I have hitherto pursued in my lectures ; 
but in the course of time it seemed to me too cinnbersomei too 
complicated y so that I shall abandon it. One may thus, it is 
true, in advancing the histological principle of classification, also 
dq justice to clinical observation ; but this will always come in 
only second rate, and there lies the mistake. The histological 
consideration must combine with the cUniccd^ but the latter 
must be the leading principle. Finally, ike newest expedient 
should be mentioned, which Virchow has rather indicated than 
elaborated, namely, to bring into another form the old distinction 
of homology and heterology of tissues, — Virchow wishing heterol- 
ogy to be understood as signifying, not, as formerly, the differ* 
ence of the new- formed tissue from other normal tissues at large, 
but the difference of the new from the mother-tissue, in which it 
arose. I confess that I do not perceive the advantage of such a 
distinction,* either in a histological or in a elinical sense ; for 
since all neoplasms arise from connective tissue, all that are not 
connective- tissue -tumors would have- to- be classed as heterolo- 
gous formations. But even without thus drawing the conclusion 
strictly in accordance with histology, the- said distinction would 
not be satisfactCM'y in itself. Virchow has, however, pointed out 
a new course in another direction in saying, that the malignity of 
tumors is a various one, and a certain scale must be adopted for 
it. This leads to the very point which I intend principally to 
carry out in the following lines, and for which I could only after 
prolonged clinical observations adAice complete evidence, namely, 
that the fault, in respect to the manifold di&ulties in the classi- 
fication, rests not with the histologists, but with the surgeons, — 
that the clinical division of tumors into benign and malign is in- 
correct snd due to inaccurate observation, as has been already 
mentioned above. The system of surgery must therefore make 
certain concessions in this direction, and conform mor9 to accu- 
rate observation, on which the anatomical tendency of this age, as 
a strictly observing school, has, it is true, exerted the most decided 
cfluence, that should not be underrated. 



Cla99ifieaiian of Tumors. 245 

When I Yentore to adTanee a sort of new classification oF psen- 
doplasms, which shall correspond as far as possible to practical 
interests, I do so, becaose I believe I am in possession of a suffi- 
ciently ample fnnd of observations on tumors, at least as far as 
surgery is concerned, and because I always strove to turn this 
material to advantage in all dir.ections. The prognostic princi- 
pie of classification! which hitherto was familiar to physicians — 
the faculty of recurrence in variable degree and extent — ^I regard 
as perfectly competent for practical purposes, and therefore re» 
tain it in the main. In the designation of the various forms of 
tumors I have likewise altered nothing and retained the usual 
names, but eliminated those names, which were chosen according 
to microscopical elements ; they may be reserved to histologists 
for the more minute distinctions. The consistency and the simi- 
larity to normal forms have occasioned the most current names, 
and it would be a vain endeavor to substitute other denominations 
for them ; the majority have been chosen very pertinently by our 
forefathers. On the whole, I pay especial regard in this classifi- 
cation to the requirements of the educated physician. The de- 
lineations of the characteristic marks of the various forms of 
tumors are therefore but short, and look principally towards the 
prognosis; ihejf all have reference to eases which I have ob* 
served myself so that I am able to bear out every remark that 
may appear new, with examples. For the histologist only here 
and there a few points could be thrown in. Whoever has examin- 
ed many tumors, will agree with me, that, in most cases ^ one can 
predict from the mere accurate inspection of the tumor with the 
naked eye, how it is constituted microscopically ; but there are 
in this respect many exceptions that may deceive the most ex- 
pert, since the multiplicity of minutest forms is especially aston- 
ishing in tumors. 

I. TUMORS WHICH BUT SBLDOM RETURN AFTER EXTIRPATION, BUT 
SOMETIMES OCCUR DISTRIBUTED IN GREAT NUMBERS OVER THE 
WHOLE SURFACE OF THE BODY. 

1. Simple Cysts. — ^We distinguish most advantageously after 
the old mode four species of them, namely, according to their 
contents : (a) Cysts with serous fluid. They are rare, usually 
occur single, and do not return after the extirpation of the sack ; 



2i6 Clasaifieaiion of Tumors. • 

they arise on the spermatic cord, on the neck, especially close by 
the thyroid, seldom in the ovary, in the broad ligaments of the. 
nteras, and are usually curable by injection of iodine, if this can 
be made. 

(6) Cysts with mucous contents^ {colloid cysis^) of wine 
or honey- like f yellowish or brownish color ^ (Meliceris). 
These mucous contents are not always purely a secretion of the 
walls, but often constitute a very soft tissue, {mucous tissue^ 
Sc/ileimgewebcy) the consistence of which can condense to that 
of a jelly. These cysts are found on the neck, under the tongue 
(as ranula), in the thyroid gland, in the ovary, seldom in the 
mammary gland ; they frequently occur in great numbers in one 
organ, e. g.j in the ovary and thyroid gland. The injection of 
tinct. of iodine is with these an unreliable remedy ; sometimes it 
is efficacious when repeated, but it may also lead to violent in- 
flammation and ulceration if the soft remnants of tissue are suf- 
fered partially to remain. By extirpation of the sack with the 
diseased organ these tumors are curable ; they do not invade other 
parts of the body. 

(c) Cysts with pultaceousy fatty contents. The latter vary 
greatly in regard to color and consistence ; they may be grit- 
like, semifluid, with many glistening cholesterine tablets, (Athe- 
roma, Grit- follicle — Gruetzbeutel) \ occurring often in great 
numbers especially on the head, sometimes undoubtedly in con- 
nection with general lesions of secretion in the sebaceous glands ; 
in other cases, the contents are yellowish -white, firm, consisting 
of concentric laminss, (lamellated cholesteatoma, pearly tumor,) 
also occurring on the scalp, and likewise on the biisis cranU; 
finally, the contents may be snow-white, fluid like beaten cream, 
sometimes emulsion- like, similar to pus; such cysts occur prin- 
cipally in bones, (especially the frontal and temporal,) but also 
in the ovary, on the neck, and here not unfrequently arising from 
the sheaths of vessels. Their walls sometimes present on their 
internal surface a cutis-like construction ; a rete Malpighii^ hairs, 
sebaceous and sudoriferous glands, (dermoid cysts;) in the ovary 
there may be found in them, besides, pieces of bone, teeth, and 
the like. These cysts are seldom curable by injections of iodine ; 
I am, so far, acquainted with only one case on the neck, where 
the fluid was puriform, and proved to be a fatty emulsion with 



Cla99ifieation of Tumara. 24T 

apidennic plates and eholeaterine, in which a cure was effected by 
two injections of iodine ; rapidly and with certainty this end is 
attained only by extirpating tLe sacks, provided that this can be 
done without danger to life. 

(^d) Cysts with blood are very rare ; they are liable to oocar 
on the most various parts of the body, (neck, axilla, chest, thigh ; ) 
their origin is unknown. Extravasations, of course, are here not 
included. 

2. Fatty tumors^ {Lipomata.) — ^They are frequent, occur 
almost exclusively in the subcutaneous cellular tissue, but may 
also originate in the fascisd. They may be divided in two ways : 
first may be distinguished the eircumscript and the diffuse 
form. That form, which is definitely limited against the sur^ 
rounding parts by a sort of connective tissue capsule^ is fre- 
quent on the neck, back, abdominal walls, and these tumors attain 
an enormous size ; sometimes they ulcerate superficially ; their con- 
struction is usually lobular ; calcifications and even partially true 
ossifications may take place in them, and* then the adipose tissue 
of some lobes is transformed into an emulsive or purely oily 
fluid ; this is however a rare metamorphosis ; commonly they re- 
main, consisting uniformly throughout of adipose tissue ; the lat- 
ter varies in color and consistence, inasmuch as lipomata may 
look white as lard, but in most cases appear yellow, soft and 
lobular, like the common fat of man. When these tumors are 
carefully extirpated they do not return. But hundreds of them 
may form on the body simultaneously. 

The diffuse form of lipomata is much less frequent ; it pro- 
ceeds from a hyperplasy * of the subcutaneous cellular tissue, 
and occurs congenital on the extremities and in the face, but 
may also be developed at a later period ; the superfluous tissue 
can here be removed only by elliptical excisions, and the disease 
cannot always be remedied entirely by the operation ; sometimes, 
however, the formation of fat will come to a stand -still after some 
of it has been removed. The Lipoma arborescens of J. Muel- 
ler occurs in joints and in the sheaths of tendons ; it is an exuber- 
ant production of fat in the synovial villi (analogous to the ap' 
pendices epiploicas)^ and seldom has the import of a pseudo- 

* Increased development, maltiplication of the elements, former!/ comprised 
«Bder the general name of hypertrophy.— Tk. 



248 Cbusifieatian of Tumors. 

plastic process ; no case has yet oecarred to me th^t was of any 
surgical importance. 

The lipomata are also subdivided in another direction, namelys 
into simpk and compound; the latter are combinations of adi- 
pose tissue with others. Among them is especiallj to be men- 
tioned the combination with firm fibrous masses, the fibrous 
lipoma ; it is rare, occurs in young individuals, proceeding from 
fasciae (dorsal fascia, inguinal ring, hand), and is usually a 
tumor that extends by many branches and lobes between muscles 
and tendons, is diflicult to extirpate entirely, and therefore liable 
to return. In the other combinations of the lipoma (with sofi 
connective tissue, mucous tissue, medullary mass, cavernous 
angiectasia), the adipose tissue exists always in less quantity 
than the other resp. tissue, and the latter determines the impor- 
tance of these combined tumors. 

8. Fibrous tumors. — Of these, two different kinds must be 
distinguished : 

(cj) The soft fibrous tumor (connective -tissue- tumor) ; it 
is purely white, tough as thick cutis, and occurs also congenital 
as hypertrophy of the skin, either as a thick protuberance {s. g,^ 
on the cheeks, lips), or as a pedunculated tumor, (MoOuscum 
simpleXj Dermatolt/sis^ Cutis penduloy) sometimes expanded in 
great masses over the whole body, and in the face, mostly on one 
side only, as vegetations resembling the comb of a cock ; it com- 
bines with brownish coloration of the skin, excessive development 
of hair, and with capillary ectasis and the production of fat. If 
these tumors are developed at a later period, they appear more 
especially on the labia pudendi as pedunculated, lobate tumors, 
mostly a long time concealed, and hence very large (sometimes 
termed Elephantiasis) ; they do not return after extirpation. 

(J) The hard fibrous tumors^ fibroid tumors^ desmoid tu^ 
morsy are, as is notorious, most frequent in the uterus ; their 
structure is in general well known, although it is by no means 
very clear, whereon is based the peculiar arrangement of the fibres, 
so very conspicuous on the surface of a cut, and the variegated 
gloss. The connective tissue, here firmly interwoven, is of a 
peculiarly rigid, brittle texture. Considering, first, the fibroid 
tumors of the uterus, we find in them ordinarily a large amount 
of organic muscular fibres, sometimes extensive calcification, 



CiMiifieaiion of Tumors. 249 

rarely osaification of the tissue. The form in which these tumors 
appear, is either round, knotty, for the most part accurately Urn* 
ited ; and in these cases the fibroid growths become more or less 
pedunculated, projecting into the abdominal cavity or into the 
vagina, according as they are developed in the fundus or in the 
cervix; or they are less circumscript, more interstitial, partly 
protruding out of tho os; the latter form is rare, sometimes con- 
sists of organic muscular fibres, and is separable into bundles in 
different directions. Considering the difficulty of removing radi- 
cally those fibrous tumors of the uterus capable of operation, it 
is not astonishing that local relapses occur. 

On fascise, and on the periosteum also, pure fibroid tumors are 
not unfrequent ; they are remarkable for their enormously firm 
adherence to the surrounding soft parts, not seldom send a num- 
ber of knotted branches into the neighboring parts, and are there- 
fore sometimes exceedingly difficult to extirpate. The perios- 
teum of the tibia is a favorite seat of these tumors, and h^e they 
are not unfrequently painful ; from the periosteum of the clavi- 
cle,, also, I saw two fibroid tumors extirpated; in these localities 
they often partially ossify. The fasciffi of the thigh, abdominal 
walls and back, sometimes produce fibroids too. This form of 
fibrous tumor may further appear as fibrous nasal or naso-pharyn- 
geal polypi ; in bones it is rare. I saw it only in the upper max- 
illa, — still rarer in glands, e. g.j in the mamma; but more fre- 
quent again on nerve trunks as neuromata. 

Fibroid tumors destroy bones by pressure, when they are near 
them, and thus become dangerous, e. ; ., when, as fibrous polypi 
of the pharynx, they grow upwards and perforate the bcuis cranii. 
The principal danger of these tumors lies in hemorrhages ; a ten- 
dency to superficial ulceration with the firmly attached skin is 
peculiar to them ; from these apparently trifling wounds arterial 
hemorrhages of such violence may take place as to leave the 
patient almost anaemic ; this is equally true of fibrous polypi of 
the uterus, nasal polypi, fibroid tumors of the fascise and of the 
periosteum. The tumors are extraordinarily destitute of capil- 
lary blood-vessels, but contain quite a number of small arteries; 
these have no distinct external tunic, the latter being merged in 
the fibroid tissue; when, therefore, a small artery is corroded, 
the rigid orifice remains open, because the vessel cannot retract ; 



S50 Classificaiion of Tumors. 

in this manner I wonld explain the paradox, that the tomors most 
devoid of blood can bleed most profusely. 

No well authenticated case is known to me of pure fibroid tu- 
mors returning after radical operation, and extending over the 
body in general. The cases of Paget I cannot recognise as pure 
fibroid tumors ; they are combinations with sarcoma; for fibroid 
tumors can combine with different forms of sarcoma and then as- 
sume a totally different character. I observed a fibroid tumor of 
the upper jaw, which was combined with mucous tissue and re- 
turned three times after extirpation; in other cases, combinations 
with various other forms of sarcomatous tissue occur, and in ac- 
cordance with the character of the latter must the prognosis be 
determined. In many fibrous tumors, (in those of the uterus 
also,) small fissure- like cysts are found, which, however, are 
without practical importance, and in regard to whidi histological 
researches are wanting. Not unfrequent seems to be the combi- 
nation of the cavernous hematoma with the fibroid tumor ; I am 
acquainted with examples of uterine and pharyngeal polypi that 
presented this combination. 

4. Pure cartilaginous tumors^ Enchondroniaia^ are situ- 
ated most frequently on the phalanges of the hand and on the 
metacarpal bones, seldom in the bones of the face ; they grow 
very slowly, without pain, and. cause, on account of their firm 
consistence, seemingly no lesion of continuity in these small 
bones and therefore come to the notice of surgeons usually but 
very late in persons of middle age, although they originate in 
youth ; nearly always there are several tumors at the same time, 
and ordinarily these originate in the periphery of the diaphysis of 
bones. I have never observed thatMin enchondroma expanded the 
cortical substance of long bones, like a bladder, although isolated 
patches of enchondroma may arise in the very centre of the medul- 
lary substance; these tumors, on the contrary, usually grow com* 
pletely through the bone. If they become very large, they may 
ossify more or less ; but the bone-substance thus formed is a very 
irregular one, partly rather a calcification of cartilage, and has a 
strong tendency to necrose, especially if the tumor begins to 
ulcerate from without inwards. In men, the production of en- 
chondromata appears to be more frequent than in women. Al- 
though these tumors occur on one or both hands at the same time, 



Clasrificaiion of Tumors. 261 

in large nnmberSi yet after the exarticnlation of the affected fin- 
gers local relapBes do not take place ; bat in recent times a more 
general development of enchondromata, especially in the lungs, 
has indeed been repeatedly observed. 

Enchondromata may also present themselves in the form of 
cystoid and colloid tumors , and then have an entirely different 
clinical cnaracter, whereof more shall be said in the second group. 
(See below.) Sometimes, too, the formation of cartilage com- 
bines in the salivary glands with glandnlar tumors, and in the 
testicles not seldom with medullary forms ; the latter, however, 
then determine the surgical importance. 

6. Exostoses occur only on bones, and are distinguished from 
osteophytes and callud, just as tumors in general are distinguished 
from chronic indurations and cicatrices. Osteophytes are pro- 
duced in consequence of chronic periostitis, and are to a certain 
degree capable of resorption ; the callus o! fractures, particularly, 
can in the course of time considerably diminish (which can be 
observed especially well in fractures of the clavicle in children). 

Exostoses are usually pretty circumscript osseous tumors, and 
are never resorbed. There are two species of them : 

(a) The spongy exostosis y lined with cartilage — exostosis 
cartiktgineaj ecchondrosis — ^is developed only at the juncture of 
epiphyses and diaphyses in individuals under twenty- four years, 
t. e.f at the time when the diaphyses are still separated from the epi- 
physes by a band of cartilage ; the latter probably grows primarily, 
and gradually ossifies. The tibia, fibula, and humerus, are pre- 
ferred by these tumors ; the spongy bone- substance (of the tu- 
mor — TV.) well supplied with blood, is intimately connected 
with the same substance of the upper or lower end of the affected 
bone ; a thick perichondrium is easily removed from the super- 
ficially overlying stratum of cartilage, 1 — 1^ lines (.09 — .18 
inches — TV.) thick; hence these exostoses are easily laid bare 
to the bone ; because of the proximity of joints, these tumors 
sometimes cannot be extirpated without danger; in such cases 
the operation should never oe pushed to the opening of the cap- 
sular ligament; according tO/Syme's observations, these exostoses 
are said to cease growing after the completion of the skeleton. 

(6) The ivory exostosis also occurs in young individuals ; it 
has neither a special covering of periosteum nor of cartilage, is 



262 CioBsificaiion of Tumors. 

nneven, rough on the surface, and has its seat preeminently on 
the bones oE the face and cranianiy and on the acapnia ; on the 
whole it is very rare. 

Exostoses do not return locally after the resection of the tu* ' 
mor from the bone ; several tumors may be present simultane- 
ously, but this also happens very seldom. 

6. Vascular tumors^ AngioplaBmata. — Aneurisms and va- 
rices in their various forms are not, usually, included among 
pseudoplasms, and are described in connection with the diseases 
of arteries and veins. Only the dilatation of capillaries, and of 
the smaller veins and arteries approximating them, are here 
counted in as so-called ieiangieclases^ erectile tumors ^ fungi 
hmmatodes* We must distinguish two kinds of them : 

(a) The telangiectasis with its prolific development of vessels 
is the commonest form ; it occurs nearly always congenital, is of 
pretty rapid growth in extent and depth, and consists of dilated, 
and for the most part new-formed, capillary and intermediate* 
vessels. These telangiectases may present a very different ap- 
pearance according as the vascular disease has its seat : ( 1 ) su- 
perficially in the vessels of the papiUse ; then a cherry-red spot, 
scarcely elevated above the skin, is produced, which gradually 
expands — or we see in the skin with the naked eye a multitude 
of little red blood-vessels that apparently have no (mutual) con- 
nection, or in other cases appear as peripheric processes of a 
red spot ; (2) deeper in the cutis or in the subcutaneous cellular 
tissue; then arises a soft elastic tumor, usually of a steel-blue 
color ; when extirpated, it collapses considerably and presents it- 
self as a light- reddish lobular mass, which may often penetrate 
deep into the fat and even into the muscles. These two varieties 
not unfrequently combine, and then cherry-red tumors are formed 
that consist entirely of vessels, and in which all parts of the skin 
are uniformly affected by the vascular ectasis and prolification. 
The safest and simplest mode of destroying the superficial forms 
of these tumors is by nitric acid ; massy tumors of this kind are 
excised, or, if the hemorrhage is thought not to be easy to arrest, 
ligated or removed by the galvano-caustic ligature ; the two last 
named methods, however, are not as safe as the extirpation, be- 

* Intermediate between capillaries and arteries or yelns; literally nanslated, 
"transition Tassels/'— Tb. 



Cla99ificaiion qf Tumors. 268 

MQse in them one cannot precisely determine whether all diseased 
parts bave been removed ; small portions remaining always give 
rise to local relapses. Telangiectases eccnr only in the skin, and, 
by spreading, in the superficial muscles, often simultaneously in 
large number, but when well extirpated they do not return, and 
such tumors are never developed secondarily in internal organs. 

(6) 7%e cavernous hmmaioma^ cavernous ectasis of veins; 
this resembles, on a section, the corpus cavernosum peniSf and 
has, indeed, nearly the same structure ; after the extirpation all 
blood has escaped, and a coarser or finer, much contracted 
network of meshes is seen with the naked eye, in which some 
coagula of blood or sometimes also small phlebolithes are found. 
(Perfectly analogous to these formations is the cavernous h/m- 
phaiie tumor J in which the corresponding network is filled with 
a lymphatic fluid ; this tumor occurs in the tongue and lips as 
macroglossia and macrochilia congeniia.^ The cavernous tu* 
mors of veins present themselves in various forms : (a) they are 
tumors strictly enclosed in a capsule, and are connected very in- 
timately with larger veins, e. g.y on the forearm ; (b) they have 
definite limits, but are fed only by very small venous and arterial 
branches, as, for instance, most tumors of this sort in the liver ; 
(o) they are without perceptible limits, and extend by a muUi- 
tude of fine processes far around in the subcutaneous cellular tis-^ 
sue ; these are sometimes joined again by varicose veins, and thus 
a limit is often not to be found at all during the operation, espe* 
dally since the tissue cannot be discovered after the escape of 
the blood, because it collapses so much that it cannot be distin- 
guished from the subcutaneous tissue ; (d) they combine in the 
subcutaneous cellular tissue with fibroid tissue, with circumscript 
and diffuse lipoma, in the skin with warty formations. The mi- 
nuter relations in the development of these tumors are not yet 
explained. It is usually assumed that the small veins dilate and 
their approximated walls are resorbed ; many cases speak in favor 
of this view, in which dilatations of veins exist in the vicinity of 
cavernous tumors, and likewise the manner in which these tumors 
are developed in bone ; in many other instances, however, the evi- 
dence for this mode of development is wanting, and investigations 
in this direction should still be continued. Sometimes the cavern- 
ous tumors, also, are congenital, but in general this is very rare; 



264 Clasaification qf Tumors. 

mostly they occur without a known canse in young indiTidualfl, 
often scattered over seyeral parts of the body at the same time 
in great number. They grow slowly , but gradually metamorphose 
all adjoining parts into cavernous tissue ; the skin coyering them 
is either unaltered and normal, or colored steel-blue by the venous 
blood shining through it ; the tumors are now larger, now smaller; 
sometimes exceedingly painful on the slightest touch, and always 
present distinct fluctuation unless they are combined with other 
tissues. When they are extirpated, they collapse at least to the 
fourth part of their volume, the swelling being based only on the 
contents of blood. Wholly extirpated they do not return, but the 
complete extirpation is sometimes very difficult, often imp088ible« 
Left to itself ihe cavernous phlebectasis attains an enormous de- 
gree of development, and may, since it not seldom occurs in the 
face and on the skull, become fatal by destroying the cranial 
bones ; at the same time cavernous tumors may then form in in- 
ternal organs also — in the liver, spleen, kidneys. In the liver, 
these tumors not unfrequently appear primarily, but never attain 
Buch a size as to become capable of being felt from without and 
of being diagnosticated ; they partly destroy the parenchyma of 
the liver without creating any material disturbances in the hepatic 
function. For the first admirable investigations on cavernous 
tumors we are indebted to Sokitansky. 

Thenaevus ielangieciodes^ mokj {Feuermeialj^ has about 
the same character as the telangiectasis, ex<$ept that the dilata- 
tion of the capillary loops of the papillsa, in particular, is con- 
siderable ; it is always congenital and has no individual growth, 
increasing only relatively with the growth of the corresponding 
portion of skin. 

7. Horny excrescences are thickenings of the horny part 
of the epidermis with participation, al: the same time, of the 
papillary body of the skin. In callosities and corns, the ex- 
cessive formation of epidermis is the principal change, as 
likewise in the cutaneous horns y which may besides arise from 
the walls of atheromata ; in warts, the hypertrophy of the cu- 
taneous papillae is more prominent, and also in Uie verruoose 
excrescences which form on the skin with contemporaneous ele- 
phantiasis. Warts occur especially on the hands of children, 
sometimes in enormous numbers, but not unfrequently recede 



ClassificQtion qf Tumors. 265 

Bpontaneoasly. The warts of the lower lip are rare, their horny 
epithelium is softer tfian that of the catis ; so long as the degen- 
eration is confined to the papillae, they are not dangerous ; these 
tumors are the ones origitialty designated as cancroid tumors ; 
they do not return after complete extirpation ; but if, by repeated 
irritation of the wart. The process of hypertrophy extends upon 
the neighboring parts, an epithelial cancer may be developed 
from the wart. The name of cancroid tumor has now been so 
completely transferred to the epithelial cancers, that the latter 
are all designated as cancroid ; we shall recur to this in the para- 
graph on carcinoma (in the 3d group). 

II. TUMORS WHICH OFTEN RBTURN LOCALLY, BUT SELDOM INVADE 
INTERNAL ORGANS. 

1. Oland'iike iumorsj MenoidSy pariial hypertrophy qf 
glands.'^Thej originally derived their name from their gland- 
like appearance, and occur almost exclusively in the mamma. 
Their importance always depends on the nature of that new- 
formed tissue, which binds the acini together. Hypertrophy of 
the gland, in itself, is not applicable to the prognosis ; it combines 
with the most various forms of tissue. A true new-formation of 
glandular substance, however, occurs preeminently only in simple 
tubular and racemose glands, and combines most frequently with 
a jelly-like connective tissue ; these productions form the so- 
called mucous polypi in different degrees of organization, in gen- 
eral always analogous to the mucous membrane from which they 
arise, and are therefore to be considered as a lobular, polypous 
hypertrophy of mucous membranes ; they are most frequent on 
the mucous membranes of the nose, rectum and uterus ; from 
the acini of mucous glands contained in them, mucous cysts of 
greater or less size may be developed (^cysiic polypi). Inas- 
much as a morbid disposition of the entire mucous membrane 
prevails in the development of these mucous polypi, it is not un- 
frequent that soon after the extirpation of one tumor another is 
formed, not considering even that the radical extirpation of these 
polypi can hardly be accomplished with certainty. A luxuriance 
of sudoriparous and sebaceous glands also occurs, but is cer- 
tainly very rare; I have never observed it. Hypertrophy of 
compound tubular glands (testicles, kidneys) has, up to this 



256 Cldssifieation (/ Tumors. 

time, not been demonstrftted with eertainty. Among the com- 
pound acinous glands, the mamma is the omj one where not only 
an independent excessive growth of one or both glands occurs, 
but individual lobules also can become hypertrophic, although 
with abnormal interstitial substance. (In this, I follow the 
hitherto generally received opinion, while according to my own 
observations a new- formation of acini does noi occur in these 
tumors. ) We have here especially to speak of the adenoid tu- 
mors. In their purest form they about resemble the gland 
during lactation ; but this comparison, too, is only approximately 
correct, because the smallest lobules are never so distinctly seen 
and felt in the hypertrophy as in the physiologically turgescent 
gland; this results, because in the tumors the interstitial sub- 
stance is never so perfect a connective tissue as in the healthy 
mamma. Adenoid tumors are of very light reddish-yellow color ; 
on a section, a pappy mucous fluid can usually be scraped from 
the cut surface ; the latter would not be distinguishable, in many 
cases, from that of a carcinoma but for containing always small 
fissures, (the lactiferous ducts of middle size,) which in a careful 
examination with the naked eye are never looked for in vain ; 
besides, the tumor is usually distinctly limited, surrounded by a 
special capsule, and thereby even to be distinguished from car- 
cinoma. 

These are llie anatomical characters ; as they vary, so also 
vary their clinical relations: if the tumor is very hard and 
brittle on a section through it, if hardly any serum can be ex- 
pressed from the cut surface, we recognize therefrom the preva- 
lence of a fibrous interstitial tissue, and the tumor belongs rather 
to the fibroids. If the cut surface is covered with a viscid, hya- 
line mucus, and has rather a light red color, then Uie interstitial 
substance between the acini consists of mucous tissue, and this 
somewhat modifies the prognosis (yid. the colloid tumors). The 
adenoid tumors may also incline towards, and finally pass into, 
carcinoma and medullary tumor, whereof more below. But in- 
variably are found in them those little fissures which never oc- 
cur in primary carcinoma of the gland, but in adenoid tumors 
may gradually expand into larger cysts ; finally, the acini also 
may dilate into mucous cysts ; and thus ensues the transforma- 
tion into cystoid tumors and cystosarcoma. 
[To be Gontinaed ] 



•ScHon of Mtdicinen on the Mental Faculties. 257 

•Action of different Medicines on the Mental Facttlties. 
By Professor Otto. 

All stinmolant and exciting medicines increase the quantity of 
blood sent to the brain. If this quantity exceeds a certain 
amount, then most of the faculties of the mind become over* 
excited. Nevertheless the degree of this action is obseryed to 
vary a good deal in different cerebral organizations ; and it is 
also found that certain stimulants exercise a peculiar and charac- 
teristic influence upon special or individual faculties. Thus am- 
monia, and its preparations, as well as musk, castor, wine, and 
ether, unquestionably enliven the imaginative powers, and thus 
serve to render the mind more fertile and creative. The empy- 
reumatic oils are apt to induce a tendency to melancholy and 
mental hallucinations. Phosphorus acts on the instinct of prop- 
agation and increases sexual aesire ; hence, it has often been re- 
commended in cases of impotence. Iodine seems to have a some- 
what analogous influence, but then it often diminishes at the 
same time the energy of the intellectual powers. Oantharides, it 
is well known, are a direct stimulant to the sexual orsans, while 
camphor tends to moderate and lull the irritability of Uiese parts. 

Of the metals, arsenic has a tendency to induce lowness and 
depression of spirits, while the preparations of gold serve to ele- 
vate and excite them. Mercury is exceeding apt to bring on a 
morbid sensibility, and an inaptitude for all active occupation. 

Of narcotics, opium is found to augment the erratic propensi- 
ties, as well as the general powers of the intellect, but more 
especially the imagination. Those who take it in excess are, it 
is well luiown, liaole to priapism. In smaller doses it enlivens 
the ideas and induces various hallucinations, so that it may be 
truly said, that during the stupor which it induces, the mind con- 
tinues to be awake while the body is aleep. In some persons 
opium excites inordinate loquacity. Dr. Qregory says that this 
effect is observed more especially after the use of the muriate of 
morphia. Ho noticed this effect in numerous patients, and he 
then tried the experiment on himself with a similar result. He 
felt, he tells us, while under the operation, an invincible desire to 

Seak, and possessed, moreover, an unusual fluency of language. 
9nce he recommends its use to those who may be called upon to 
address any public assembly, and who have not sufficient confi- 
dence in their own unassisted powers. 

Other narcotics are observed to act very differently on the 
brain and its faculties from opium. Belladonna usually impairs 
the intellectual energies; hyoscyamus renders the person vio- 
lent, impetuous and ill-mannered ; conium dulls and deadens the 
intellect, and digitalis is decidedly anti-aphrodisiac. Hemp will 
Vol. xn— 17 



258 Hydrochloric •And in Chronic Dyspep9ia. 

often induce an inextin^ishable gayety of %^m\z ; it enters into 
the composition of the intoxicating drink which the Indians call 
bauas. The nse of amanita tnuscaria is said to have inspired 
the Scandinavian warriors with a wild and ferocious courage. 
Tobacco acts in a very similar manner with opium, even in those 
persons who are accustomed to its use ; almost all smokers assert 
that it stimulates the powers of the imagination. 

If the psychological action of medicines were better known, 
medical men might be able to vary their exhibition, according to 
the characters and mental peculiarities of their patients. The 
treatment of different kinds of monomaniacal derangement also 
might be much improved, and it is not improbable but that even 
a favorable change might be wrought on certain vicious and per- 
verse dispositions, which unfortunately resist all attempts at refor- 
mation, whether, in the way of admonition, reproof, or even of 
correction. — South. Med. <• Surg. Jour. 



Hydrochloric Acid in Chronic Dyspepsia. By Dr. Schottto, 

of Dresden. 

Dr. Schottin has used hydrochloric acid with great success in 
cases of chronic dyspepsia. The curative effect of the remedy is 
attributable to two circumstances: Firsi, it suspends, like other 
powerful acids, the process of fermentation ; and, secondly^ it 
serves to dissolve the proteinaceous compounds, being, to a cer- 
tain extent, a substitute for the disturbed secretion of the gastric 
juice ; it is, therefore, the most natural remedy. In children who 
suffer from gastric and intestinal catarrh, the author prescribes 
the acidium muriaticum dilutum of the Prussian pharmacopoeia, 
in doses of six to fifteen drops, in a mucilaginous mixture, and 
adds, until the bowels are regulated, a few drops of tincture of 
opium. He orders the medicine to be taken half an hour after 
each meal, and confines the patient to a diet of milk and broth. 
In old age, when the strength of the system is gradually falling, 
disturbances of digestion are very frequent, the cause of which is 
to be found, in many instances, solely in a diminished secretion 
of the gastric juice. A double indication is to be fulfilled in these 
cases : to arrest the process of fermentation, and to stimulate 
the stomach, in order to increase the secretion of the gastric 
juice. Dr. Schottin recommends for this purpose small doses of 
chloride of sodium and sulphate of quinia, to be followed, a short 
time afterwards, by sulphuric acid. The chloride of sodium is 
decomposed by this means into sulphate of soda, and hydrochlo- 
ric acid. He prescribes ten grains of chloride of sodium and 
one- third of a. grain of sulphate of quinia, to be taken four times 



Case of Leucocythmmia. 269 

a day wrapped up in a wafer, lets the patient drink some water 
after it, ana administers, about five minutes later, eight to twelve 
drops of the elixir acidnm Halleri in a half a wineglassful of 
water. 

1)he dyspepsia of drunkards requires a double dose of sodium 
and sulphuric add. Dr. Schottin attributes the effect of hydro - 
chloric acid in typhus, anaemia, and chlorosis likewise, to its 
property of suspending the process of fermentation within the 
stomach, and or exciting the deficient secretion of the gastric 
juice. — Jirchiv. der Hoilkunde. — Southern Med. <• Surg. 
Journal. 



^ Case of Leucocythxmia. By Dr. Georgb Shbabbr, Resi- 
derU Physician y Royal Infirmary^ Edinburgh. 

A young man» aeed twenty- four, a miller by trade, admitted 
to the infirmary under the care of Dr. Gairdner, affords an inter- 
esting illustration of leucocythaemia. Three weeks elapsed from 
his admission to the time of his death, and '* the following is a 
summary of the facts of the case in regular seauence : anaemia, 
languor and debility; epistaxis; headache; bleeding from the 
gums; renal pain, with lithiasis ; febrile symptoms ; disappear- 
ance of lithic acid, and appearance of lithates and albumen ; 
diarrhoea ; reappearance of lithic acid ; uncontrollable epistaxis ; 
hsematemesis ; otitis ; exhaustion, and death." 

The crystaline deposit in the urine, on third or fourth day af- 
ter admission, consisted mainly of hexagonal crystals of the lithic 
acid, with a few of the ordinary rhomboidal crystals. These, we 
have already said, afterwards disappeared. Post-mortem ex- 
amination revealed leucocythaemia, enlarged spleen, fatty liver, 
petechise on the mucous membrane of stomach and on the serous 
surfaces of the pericardium and endocardium. 

The case detailed by Dr. Shearer gives him a field for reflec- 
tion, which he discusses in the following suggestions : 

1. Enlargement and activity of the spleen is not the only con- 
dition involving increase of the white corpuscles, there bemg at 
present a case in the infirmary in which this condition of the 
olood CO- exists with enlargement of the whole lymphatic system 
of glands, without detectable enlargement of the splenic organ. 

2. The fact of a great excess of white corpuscles in the blood 
in cases of leucocythsemia being accompaniea by constant dimi- 
nution of the red discs, appears to militate against the theory 
put forward by Wharton Jones, and supported by Bennet and 
others, that the latter are derived from the former by liberation 
of their included nuclei ; for, according to their theory, increased 



260 Ou Urmmia. 

activity in the formation of the white ought, pari pasaUy to be 
attended by increased development of red discs, while the reverse 
is the case. Comparative increase of the white corpnscles is seen 
in a variety of organic diseases, especially chest affections ; hot 
it also occurs in dysentery, diarrhoea, paraplegia, etc. ; in all of 
which one general condition was observed, viz., depreciation of 
the appetite, and emaciation. These facts. Dr. Shearer thinks, 
point to the blood itself as the primary source of origin of the 
red discs, and in all the diseases mentioned there is either a defi- 
ciency of nutritive pabulum taken into the blood for the produc- 
tion of the red corpuscles, or these are rapidly melted down to 
supply the elements of the discharge. In leucocythsemia, again, 
the nutritive pabulum is appropriated for the formation of the 
white corpuscles, the blood being thereby impoverished to the ex- 
tent to which these are increased ; development of the red discs is 
consequently kept in abeyance, and anaemia is again the result. 

3. The deficiency of color in the urine and me salts obtained 
from it depends probably upon the same cause as the pallor of 
the general surf ace, viz., deficiency of red globules and hsematin 
in the blood. 

4. Oareful study of the deposit of lithic acid seemed to war- 
rant the inference that the common or lozenge-shaped crystals is 
derived from the perfect hexagonal form by shortening of the 
lateral planes of the latter ; but this does not explain the forma- 
tion of the true rhombic crystal, which is an irregular form. 

5. Hemorrhage from various mucous surfaces forms a promi- 
nent feature of this disease, and may depend partly upon the in- 
creased tension maintained in vessels by the absolute mcrease of 
volume in the mass of the blood, and partly upon the imperfect 
nutrition of the walls of the capillaries from the inferior quality 
of the blood for histogenetic purp6ses. 

6. The white corpuscles, we know, are closely allied to fibrin 
in composition and character ; fibrin is increased in febrile and 
inflammatory diseases, and accompanying this is an increased 
elimination of lithic acid, or lithates, by the kidneys. Can any 
relation exist between the lithuria present in this case, and the 
increase of white corpuscles in the blood ? — Southern Med. tc 
Surg. Jour. 



On Ursemia. By Professor Jaesgh. — Vierteljahrschriji fur 
die prakiische Heilkundy xvii. Jahrgang., I860. 

The author of this paper holds that there are two varieties of 
uraemia which should be carefully distinguished; one being 
caused by the decomposition of urine and absorption of carbon- 



On Uraemia. 261 

ate of ammonia into the blood (ammon»mia), the other beiog 
the yariety which accompanies Bright's disease of the kidneys. 
He has seen the f orlher occur nnder the following circumstances : 

1. In torpor and paralysis of the bladder. 

2. In dilatation of the pelvis and callices of the kidney in con- 
sequence of the ureters being blocked up. 

8. In renal abscess, renal tuberculosis and sacculated kidneys. 

The following are the main differences characterizing the two 
forms of ursemir ; we shall, to save circumlocution, use the word 
ammonsBmia as the name of the one, and Bright's uraemia as the 
name of the other : 

1. In advanced ammonaemia the urine discharged from the 
bladder manifests a strong ammoniacal odor, which Prof. Jaksch 
has never noticed in any stage of Bright's uraemia. 

2. Dropsical symptoms, either acute and febrile, or chronic 
and afebrile, have not been observed in ammoncemia. 

3. Advanced ammon»mia is characterized by persistent dry- 
ness of the mucous membrane oovering the mouth and fauces, as 
if every particle of moisture had been removed by blotting-paper; 
the memorane looks dry and shining, and the dryness even ex- 
tends to the mucous membrane of the nose, the conjunctiva, and 
even to the chordse vocales; these symptoms do not occur in 
Bright's urssmia. 

4. The distinctly ammoniacal odor of the air exhaled, and of 
the cutaneous secretions of patients affected with ammonaemia, 
does not occur in Bright's disease. 

5. Patients suffering from ammonssmia always show a marked 
dislike to meat, and especially brown meats, even if their affec- 
tions have not advanced very far ; a feature rarely seen in the 
other variety. 

6. Prof. Jaksch has never observed in Bright's disease the 
violent intermittent rigors, stimulating intermittent fever, which 
occur in ammonaemia. 

7. In none of the cases of ammonaemia were convulsive or 
epileptiform attacks, nor croupy or diptheritic exudations noticed. 

8. Disturbed vision, as produced in Bright's disease by exuda- 
tion on the retina, does not appear to take place in ammonaemia. 

9. Chronic ammonaemia is characterized by a uniformly pale 
and sallow complexion, and by gradually increasing emaciation ; 
very acute and advanced ammonaemia is associated with very 
rapid wasting of features, and muscular debility amounting to 
paralysis. 

10. In all cases of ammonaemia which ran a rapid course there 
was vomiting, with concurrent or consequent diarrhoea ; in chronic 
ammonaemia both phenomena were often entirely absent, or only 
occurred temporarily. 



262 Therapeutic Value of Ergot. 

11. In ammonaemia, whether acute or chronic, Prof. Jaksch 
has always seen death occur after sopor, varying in duration from 
several hours to several davs. ^ 

The author of this valuable and interesting paper gives numer- 
ous cases illustrative of his views, and enters very fully into the 
various questions connected with diagnosis and treatment, for 
which we are unable to make room. — Ibid. 



THBRAPEUTIO YALUB OF BBGOT. 

In a long and very able article on Ergot — the SecaU Cornu- 
turn — by E. N. Chapman, M.D., of New York, Professor of 
Materia Medica and Therapeutics in the Long Island College 
Hospital, and published in the Boston Medical Journal, the fol- 
lowing deductions are given. The whole article is worthy of 
perusal, but is too long for our pages. — ^Eds. 

In conclusion, we will briefly recapitulate the main points, de- 
duced from the data hitherto presented. 

Ist. The active principles of ergot are the products of a plant, 
the odium abortifaciens. These are peculiar to it, and are in no- 
wise more dependent on the grain- germ than any plant is on the 
soil that affords it nourishment. 

2d. These principles — not as yet isolated — are, probably, two 
in number; one of which, contained in the oil, produces narcotic 
symptoms, and eventunlly gangrene ; the other, remaining in the 
residue after the extraction of the oil. acts by stimulation on the 
motor tract of the spinal marrow at that limited portion whence 
the uterus and contiguous muscles receive their nerves of motion. 

8d. The oil is alone efficacious in any form of hemorrhage, ex- 
cepting in that from enlarged uterus, and we can only look for 
favorable results when the system has been brought under its in- 
fluence, as shown by a narcotic impression on the brain and heart. 

4th. So hazardous a treatment cannot be countenanced ; since 
we possess other remedies of known virtues, not only more relia- 
ble, but unattended with any risk. 

5th. The watery preparations, which, lacking the oil, can be 
given many days in succession, will act on the motor tract of the 
spinal marrow, but will not induce ergotism or other evidence of 
a narcotic poison. 

6th. Ergot of good quality causes the uterus to contract with 
great certainty whenever its cavity is distended, either by a foetus 
or a morbid growth. These contractions are tonic and continu- 
ous, with periods of remissions and exacerbations. 



Trtaiment of JVh^ralgia. 268 

7th. Hence, this remedy may originate uterine pains at any 
period of gestation, or cause the expulsion of clots, hydatids, or 
any other unattached substance. 

8th. Likewise, after labor, it will check an excessive flow by 
closing the mouths of the bleeding vessels through a condensa- 
tion of the muscular fibres of the uterus. In relaxed conditions 
it will be, on the same principle, beneficial in after-pains attended 
with a copious show. 

9th. Since we know of no other mode by which ergot can im- 
mediately arrest hemorrhage from the pregnant uterus, it should 
be avoided in all cases where a hope still remains of saving the 
conception, and its agency invoked only when the foetus is dead 
or the safety of the mother becomes our first duty. 

10th. In premature labor, induced by ergot, or in labor at the 
full period, where this drag is given, the child's life is jopardized 
in all cases, where, for a considerable period previous to the deliv- 
ery, the uterus is thrown into violent spasmodic action; since 
thus the supply of oxygen will be most eflfectually cut off. 

11th. Where the child is viable, the ergot should never be used 
as an expulsive agent to increase pains, already powerful, or 
overcome resistance from the soft parts of the motner. 

12th. It may be rcouired in cases of inertia of the uterus where, 
with all the parts relaxed, we are quite certain, both from the 
present appearances and the history of former labors, that the 
child would be born in four or five vigorous natural pains. 

13th. The dangers to the mother from the use of ergot, arise 
from the uterus, thus stimulated, rupturing the unyielding parts 
in its transit. Thus the neck of the uterus, the bladder or the 
perineum may receive serious injury. 

14th. Rupture of the uterus could hardly occur, excepting in 
a diseased organ. 

15th. A premature foetus from its small size and the yielding 
nature of the cranial bones could scarcely, under any uterine ef- 
fort, cause damage to the soft parts of the mother. — Chicago 
Medical Examiner. 



TREATMENT OF. NEURALGIA. 

H^rard speaks in the highest terms of sub -cutaneous injections 
of the sulphate of atropine, with the small syringe of Ravaz. A 
fine trocar is first inserted, then taken out, and the tube, remain- 
ing in the wound, screwed on to the syringe. One drop of the 
solution is injected at a time, followed shortly by from five to nine 
more. This quantity corresponds to three or five milligrammes 
of the sulphate, the solution holding thirty centigrammes of the 



264 Treaimeni of JVhiralgia. 

atropine in thirty grammes of distilled water. In twenty-five in- 

{'ections do evil consequences whatever appeared in the neighbor- 
hood of the wound, but general symptoms always became mani* 
fest in a few minutes ; dryness of the mouth and fauces, head- 
ache, dizziness, sometimes dilatation of the pupils, disturbance 
of the vision, nausea. AH these symptoms digappeared in less 
than twenty- four hours. Of ten patients thus treated, three were 
suffering from ischias, three from muscular rheumatism, two from 
muscular pains combined with hemiplegia, one from a contusion, 
one from a facialgia. Relief followed always, except in the con- 
tusion ; but most of the cases required several injections in the 
course of a few days. The result was most evident and surprising 
in the ischiatic affections. — U Union MediccUy 1859, p. 92 ; 
Oeattrr. Ztitschri/t fur Prakt. Heilk. 

The treatment of neuralgia by the injections of narcotics and 
sedatives has been ably expounded, with illustrating cases, by Dr. 
A. Ruppaner of Boston. His first step is to determine the pre- 
cise seat of irritation, to localize the pain. According to Val- 
leix, (Traits des Neuralgies, Paris, 1841,) the points from which 
all really neuralgic pains proceed may be arranged under four 
heads : 1. The place of emergence of the nervous trunk, for 
example, the trifacial at the supra and infra- orbital and mental 
foramen ; 2. The point where a nervous twig traverses the mus- 
cles to ramify on the integuments, similar to the parts which are 
traversed by the posterior spinal nerves ; 3. The point where the 
terminal branches of a nerve expand in the integuments, as the 
terminal principal branches of all the cutaneous nerves, among 
which we may mention the anterior part of the intercostal nerves ; 
4. The point where nervous trunks become superficial during 
their course, as the peroneal nerve. 

It would require too much space to give a complete list of all 
these points, described by Valleix with admirable indnstiy and 
precision. Fortunately they are easily discovered by going over 
the affected nerve with the edge of a small coin ; as soon as the 
starting-point is touched, even during the absence of pain, the 
distress oF the patient clearly indicates where the injection is to 
be made. Relief can of course only be expected where the affec- 
tion is of an idiopathic character, not dependent on disease of 
the brain, morbid condition of the bones, etc. In such instances, 
the local manifestation in the conducting nerve may to a great 
extent be under the influence of treatment specially directed to it, 
yet this will, for obvious reasons, do little good^ if, indeed, it 
ever proves beneficial at all. The injections used by Dr. Rup- 
paner are of different strength, one, two, three, or four grains of 
acetate of morphia being dissolved in one drachm of sherry wine. 
Of this solution from ten to twenty drops are injected. (Ede- 
matous swelling usually follows, accompanied by drowsiness, dif- 



TVeaifneni of JViurafgta. 265 

ferent sensations all over the body, nausea and vomiting ; bat the 
pain generally subsides soon, ana all these unpleasant symptoms 
disappear in the course of twenty-four hours. Should the sick- 
ness of the stomach prove too embarrassing, it may be relieved 
by the sub-nitrate of oismuth, one scruple in an ounce and a half 
of the compound infusion of gentian, and half an ounce of mint- 
water, a teaspoonful every half hour. Warm hops form a good 
application to the oddematous swelling. 

In all cases where the cutaneous, and particularly the superfi- 
cial cutaneous nerves have been the seat of the malady, this treat- 
ment has answered the most sanguine hopes. Even in cases of 
long standing, when combined with constitutional treatment, it 
has given relief, after all other possible expedients have been tried 
in vain. The constitutional treatment is a principal condition of 
success. Almost without exception a tonic treatment is indica- 
ted, and vegetable tonics are preferable. The sulphate of qui- 
nine is usually followed by good results. A tonic course ought 
to be adopted, with few exceptions, from the commencement of 
the treatment, going hand in hand with the local applications, 
which latter should not be resorted to (?) until other remedies 
have failed. In mild cases, or such of short standing, a solution 
of the valerianate of ammonia will often do good service, either 
alone or in conjunction with the injections. — Boston Med. 4* 
Surg. Jour, 

Dr. L. D. Robinson of New Elizabeth, Ind., in trying to elu- 
cidate the ill-understood pathology of idiopathic neuralgia, ar- 
rives at the conclusion, that the principal exciting cause is a 
deranged condition of the blood, with an excess of saline matter 
over the red corpuscles, which condition is brought about by any 
debilitating influences, such as anaemia, malaria, etc. A rational 
treatment ought therefore to consist of tonics, of which the min- 
eral, and especially the ferruginous tonics are stated to be the 
most efficacious ; but as a general thing these require to be com- 
bined with a vegetable anti-periodic remedy, especially in mala- 
rial districts. As a specimen, some prescriptions are given for 
hemicrania: Chinoidinc, twenty- four grains; pulvis an. cap. (so 
it reads in the original paper ; if it is not an error, for pulvis 
capsici annui, we are at a loss to determine what it means), five 
grains ; strychnia, one grain. Make ten pills ; one of them is 
to be taken before each meal. After using them sufficiently long 
to break down the paroxysms, they are replaced by the following : 
?. — Quevenne's iron, sixty grains ; 

Quinine, " " 

Extr. hyosdami, forty ** 

Pulvis an. cap., twenty •* 
divide into forty pills. Dose, one pill after each meal, and to 
be continued until completely relieved of debility. 



266 Treatment of ^fkuraigia. 

It must not be overlooked, that there is another form of nearal- 
eia, denominated symptomatic^ because it is dependent upon a 
diseased condition of organs connected with the affected nerve, 
commonly some kind of irritation; for instance, nephralgia 
caused by a calculus in the kidney or ureter. Cases of this kind 
generally demand depletives and narcotics, especially the latter. — 
Chic. Med. Examiner* 

Besides the rules laid down above, there is another one never 
to be lost sight of in the treatment of so many -shaped an af- 
fection as symptomatic, or, to use a more appropriate term, 
secondary neuralgic pain. It is the old truism : dtkta causa 
tollitur effectue. If we can remove the existing cause of the 
pain, the latter will seldom require much attention, unless a too 
long continued morbid influence has developed the secondary to 
a primitive affection. 

Affusions of ether are believed by Dr. Betbeder of Bordeaux 
to be superior to all the methods ordinarily used. He pours fif- 
teen, thirtv or sixty grammes of ether on the most painful points, 
covering them immediately by a small square of linen, which is 
kept in the closet adhesion to the skin by an assistant. Small 
quantities of ether are poured on the linen at intervals of about a 
minute. In recent cases, the relief is stated to be almost instan- 
taneous, and frequently there is no return of the trouble. In 
Ujeuralgia oE long standing the effect is much less certain, but in 
several cases a cure has been effected. — U Union de la Oironde. 
J>r. Y. Med. Press. 

Dr. Jueneau de Mussy has prescribed for three years a mix- 
ture of chloroform and aconite aeainst neuralgia in different 
regions, but chiefly in facial neuralgia, producing sometimes a 
complete and permanent cure, and always an almost immediate 
and considerable relief. When the neuralgia appears to be idio- 
pathic, the formula is : two parts of spirit of wine or cologne- 
water, one part of chloroform, and one of tincture of aconite. 
The finger, covered with a piece of lint or soft thick linen, is 
dipped in the mixture and rubbed gently against the gum for a 
few minutes. When the pain is connected with some organic dis- 
ease, as a deranged tooth, chronic infiammation of the gums or 
even superficial necrosis of the bone, the tincture of iodine is a 
very beneficial substitute for spirit of wine in the above formula. 
It is chiefly in neuralgia of the infra- orbitary branch that the ap- 
plication has been successful, but it answers almost equally well 
in pain of the lower branch, and has been attended with satisfac- 
tory results in some very severe cases of supra- orbitary neural- 
gia, thus showing that the sedative agent may produce its effect, 
as the irritating one so frequently does, on a part distant from 
the spot on which it was applied, and even in a different branch 
of the nerve. — Med. Times Sc Oaz. 



Premaiure Labor and JSbortion. 267 

Dr. F. P. Bibby found no remedy more beneficial in neuralgia 
than the iodide of potassinm, in fall doses. Exciting the secre- 
tions and excretions, it may be supposed to act by eliminating the 
morbid causes, and in this way probably its eflfect is to be explain* 
ed in chronic rheumatism, chronic syphilis, and other analogous 
conditions. For the same reason it may be expected to cure 
neuralgic troubles generally. — Md. 4* ^« Med. Jour. 

According to Dr. Th. Roche ( Bullet, de la Soc. MSd. de 
Beganfony JVb. 8), the solution of two or three decigrammes of 
cyanide of potassium in thirty grammes of water cures neuralgia, 
if it is superficial and localized. In ten cases of cephalic neural- 
gia and one of pleurodinia, nine cures were obtained — seren times 
by the simple and sole application of the topical remedy, and 
twice by associating it with the internal use of preparations of 
belladonna. In the two unsuccessful cases the treatment consist- 
ed of the external application of the cyanide and the internal 
administration of the narcotic solanacese. The solution seems to 
act by cutaneous absorption of the salt in the state or cyanide or 
free hydrocyanic acid. — Echo Medical Suisse. — JVbrth ^mer. 
Med. tr Chirurg. Review. 



Induction of Premaiure Labor and Abortion. 

Three very instructive cases of this kind are reported by Prof. 
Henry Miller of Louisville. 

Mrs. B , having lost three large and well developed chil- 
dren at the full term, on account of Uie necessity of resorting to 
the perforator and crotchet, applied for advice during the fifth 
month of her fourth pregnancy. A morbid inclination of the 
superior strait of the pelvis was manifest, giving an unusually 
low position to the external genitals ; but the os uteri could be 
reached only with difficulty, while it was impossible to ascertain 
the sise of the womb itself, or the presence of any reliable symp- 
tom of pregnancy. Two months afterward, however, these symp- 
toms had developed themselves sufficiently to allow a correct 
diagnosis, and two weeks later the induction of premature labor 
was undertaken. For this purpose, the uterine douche, so strong- 
ly ureed in preference to all other methods by the late Professor 
l^iwish, was resorted to, the apparatus designed by Eiwish being 
emplayed, with a slight variation. To the Dottom of a tin box, 
about ten inches square, and holding about four gallons, an India- 
rubber tube twelve feet long was attached by a screw and nut. 
The tube had a metallic tube, fashioned at the end like the nozzle 
of a common enema syringe, affixed to its other extremity. In- 
stead of arranging the apparatus to act on the principle of the 



268 Premature Labor and JSbortion. 

syphon, as recommended by Kiwish, a stop -cock was adapted to 
the tube aboat two feet from its metallic end. To pat the appa* 
ratus in operation, the box must be saspended on a nail driven 
into the wall, say nine or ten feet from the floor ; the tube is 
screwed on, and the cock tamed so as to prevent the flow of water 
till it is wanted. The patient takes her seat on a stool placed in 
a bath-tub to receive the water; the metallic noszle is introduced 
into the vagina, and brought in contact with the os uteri. The 
tin box having been preyiously filled with water, the stop -cock is 
turned so as to pour a continuoas stream upon the os uteri, until 
all the water in the box is discharged. Eiwish preferred to use 
warm water in douching, directing it at first or a temperature 
upward of 100 deg. Fahr.,'and afterward raising the temperature 
considerably hieher. 

In this way the douche was applied first once, then twice, a 
day. After three days, the fundus uteri was found lower in the 
abdomen, the os softened and dilated, but no labor pains. Two 
days more brought rather a tardy progress, and for that reason 
the suggestion of Dr. Tyler Smith was adopted, viv., to use warm 
and cold water alternately. During the night of the next day 
the pains increased sufficiently for the expulsion of the foetus, and 
early the next morning the woman brought forth a living child, 
after a labor of average intensity and duration, and without any 
aid except that required in every case of natural labor. The 
woman had a rapid convalescence, uninterrupted by accidents of 
any kind. 

In the other two cases abortion was produced at the fourth 
month of pregnancy; one on account of a highly contracted 
pelvis, with an antero- posterior diameter in the superior strait of 
less than two inches ; and again in a lady who haa given birth to 
seven children, but was sufiering from the separation of the sym* 
physis pubis and of the right sacro- iliac symphysis, so as to be 
unable to use her lower extremities for any purpose whatever. 
In the former case, a second pregnancy, the warm and cold 
douches were kept up for a month, but utterly failed in awaken- 
ing the uterine contractions ; then the uterine sound was intro* 
dnced, and allowed to remain in the uterus until pains appeared, 
which occurred in twelve hours. Seven hours subsequently, the 
ovum was expelled. The mother recovered. 

The uterine sound was also selected for the other pitiable case ; 
but, notwithstanding its being introduced to the depth of more 
than three inches between the membranes and the anterior wall of 
the uterus, and its point being turned first toward one side of the 
uterus and then toward the other, only a slight pain followed, 
without any expulsive eff'ort. Eighteen days later, the method 
of Cohen was adopted, vis., the injection of water between the 
membranes and the inner surface of the uterus. By means of a 



Premature tLabor and Mariion. 269 

8il?6r tube not unlike a male catheter, and a fiyringe, two and a 
quaiter oonees of warm water were thrown in at noon. An hour 
afterward, there was a chill, followed by smart fever and head- 
ache. This passed off in about four hours, leaving a dull pain 
in the hypogastrium and back. In the early part of the night, 
well-marked labor pains set in, growing stronger toward morn- 
ing, and expelling the foetus at 10| o'dock a.m. By means of 
continuous and gentle assistance, the secundines came away with- 
out rupturing the cord, leaving the membranes and all attached 
to the foetus. In less than a week the mother was sent home, 
with the advice to wear a leather belt slightly buckled around the 
pelvis. — Louisville Med. Jour. 

Mal'posilion of the Foelus corrected by external Manipu^ 
lotion. — ^The evidence is fast accumulating that the position of 
the foBtus cannot only be ascertained by external manipulation, 
but also correcCed by a careful operation. Dr. E. B. Barret, 
house physician at the Bellevue Hospital, New Tork, reports to 
the New York Medical Times, as follows : Mary Ann, aged seven- 
teen years, born in Ireland, was admitted March 19, 1860, in her 
first pregnancy. Uterine tumor very conical, projecting mark- 
edly to the right as well as forward, triangular in shape, with its 
transverse diameter greatest ; os uteri dilated to the size of a 
dollar, and dilatable ; membranes very full, projecting strongly 
from the os, but so tense that no part of the child could be felt, 
from danger of rupturing them ; pains rather teasing. Little or 
no progress being evident until next morning, an opiate was ad- 
ministered, resulting in a refreshing sleep, after wnich the pains 
increased in force and frequency, but witn no result save tiie fur- 
ther dilatation of the os. The previous conjecture that a trans- 
verse presentation existed, was rendered nearly certain by palpa- 
tion. Prof. Barker came to pay his daily visit, at this juncture, 
and, concurring in the opinion just stated,. decided on immediate 
interference. The patient being brought under the influence of 
chloroform, the head could be felt through the abdominal wallet, 
in the left iliac fossa, above the pubis ; the pelvic extremity of 
the foetus in the right iliac fossa, and the curve of its back 
strongly projecting forward ; consequently the right shoulder was 
the presenting part. Cephalic version was decided on in prefer- 
ence to the ormnary metnod, and Dr. Barker at once proceeded 
to the operation. The patient beinff brought to the edge of the 
bed, in the approved position, he first attempted to elevate the 
pelvis of the foetus with his left hand, and to dejnress the head 
with the right, acting only when the uterus was not contracting. 
As soon as he had succeeded in changing the position of the 
foetus, strong pressure was applied over Uie left iliac fossa by 
an assistant, while Barker, still elevating the child's pelvis witL 
his left hand, introduced two fingers of the other into the vagina, 



270 Mormonism^ in its Physical •Aspects ^ 4*c. 

and rnptnred the membranes daring a contraetion. The waters 
escaped with great force and abundanoe, and the head coald now 
be felt in the snperior strait. The administration of chloroform 
was now discontinued. Slight pains, with little progress, follow- 
ed for fifteen minutes, and as tne foetal heart was beating some- 
what feebly, it was then deemed necessary to apply the forceps. 
With them, a male child, weighing eight poands, was extracted in 
a partially asphyxiated condition. Respiration, however, was 
established in a short time. The placenta came away in five min- 
utes, with no more than the usual amount of haemorrhage, and 
the mother proceeded to a rapid recovery. 

[Cm. Lancet tr Observer. 



Mormonismj in its Physical^ Mental and iioral Aspects. 

The following is a brief extract from the sanitary report of 
Assistant Surgeon Bartholow, oneof the medical officers attached 
to the army corps, which passed the winter of 1867--8, in Utah. 

c^The Mormon, of all the human animals now walking this 
fflobe, is the most carious in every relation. It would be quite 
beyond the scope of this report to say anything of the political 
and religious aspects of Mormonism ; but as a great social sole- 
cism, seriously affecting the physical stamina and mental health, 
it is full of interest to the medical philosopher. Isolated in the 
narrow valleys of Utah, and practising tne rites of a religion 
grossly material, of which polygamy is the main element and 
cohesive force, the Mormon people have arrived at a physical and 
mental condition, in a few years of growth, such as densely 
populated communities in the older parts of the world, hereditary 
victims of all the vices of civilization, have been ages in reaching. 
This condition is shown by the preponderance of female births, 
by the mortality of infantine life, by the large proportion of the 
albuminous and gelatinous types of constitution, and by the strik- 
ing uniformity in facial expression and in physical conformation 
of the younger portion of the community. The ^peculiar insti- 
tution' is practically upheld by the older men, the eiders, bishops, 
apostles, and prophets ; and so eager is the search for young vir- 
gins, that nothwithstanding the preponderance of the female pop- 
ulation, a large per centage of the younger men remain unmar- 
ried. To sustain the system, girls are ^sealed' at the earliest 
manifestation of puberty, and I am credibly informed that means 
are not unfrequently made use of to hasten the period. The ac- 
tivity of the reproductive function, as a rule, is not diminished 
by polygamy ; on the contrary, the women are remarkable for 
fecundity ; but in the harems the proportion of children arriving 



Murmontsmj in lis Physical Jhpecta^ ttc. 271 

at maturity is much less than in the rural districts of our country. 
An illustration of this fact is afforded by the results in that chief 
of polygamistSf Brigham Toung's case. He has, at least, forty 
wives. A large number of children have been born to him, a 
majority of whom died in infancy, leaving twenty-four, according 
to the most reliable accounts. These forty women in monoga- 
mous society, married, would have probably one hundred and 
sixty children, two- thirds of whom, under hygienic circumstances 
equally favorable, would have been reared. In Brigham Young 
and his wives, we have presented the most favorable conditions 
for successful polygamy possible in Mormon socie^, yet, in this 
instance, the violation of a natural law has been speedily evinced. 
One of the most deplorable effects of polygamy is shown in the 
general weakness of the boys and young men, the progeny of 
tne 'peculiar institution.' The most observant Mormons cannot 
hide from themselves the evidence of these sad effects. One of 
their saints, Heber C. Kimball, in recent sermons, has adverted 
to this sexual debility, but, with a singular blindness , attributed it 
to a vicious style of dressing. The sexual desires are stimulated 
to an unnatural degree at a very early age, and as female virtue 
is easy, opportunities are not wanting for their gratification. It 
is a curious fact, that Mormonism makes its impress upon the 
countenance. Whether owing to the practice of a purely sensual 
and material religion, to the premature development of the pas- 
sions, or to isolation, there is, nevertheless, an expression of 
countenance and a style of feature, which may be styled the 
Mormon expression and style ; an expression compounded of sen- 
suality, cunning, suspicion, and a smirking self-conceit. The 
yellow, sunken, cadaverous visage; the greenish- colored eyes; 
the thick, protuberant lips; the low forehead; the light, yellow- 
ish hair ; and the lank, angular person, constitute an appearance 
so characteristic of the new race, the production of polygamy, 
as to distinguish them at a glance. The older men and women 
present all the physical peculiarities of the nationalities to which 
they belone; but these peculiarities are not propagated and con- 
tinued in the new race ; they are lost in the prevailing Mormon 
type. 

''If Mormonism received no additions from outside sources, 
these influences continuing, it is not difiScnlt to foresee that it 
would eventually die out. The increase of population indepen- 
dently of large annual accessions from abroad, has not been co* 
equal with the increase in other portions of our country. The 
results of polygamy here are not to be compared, without some 
limitations, to the results of the same institution elsewhere; its 
decadence must follow more speedily. In eastern life, where it 
has been a recognized domestic institution for ages, women are 
prepared for its continuance, and do not feel degraded by their 



272 Cannabis Indiea as a Hypnotic* 

association with it. The women of this Territory, how fanatical 
and ignorant soever, recognize their wide departure from the 
normal standard in all Christian countries ; and, from the degra- 
dation of the mother, follows that of the child, and physical de- 
generacy is not a remote consequence of moral depravity. 

^'Mormonism, considered in a relation purely sanitary, pre- 
sents some interesting features. The Mormon theology contem- 
plates the cure of disease by miraculous interposition ; hence the 
aisciples of the healing art are not held in much estimation. 
The church authorities are exceedingly jealous at an attempt to 
cure by ordinary therapeutics, and denounce from the pulpit any 
invasion of their special province. Though they claim for the 
^ laying on of hands' {chetrapsia) wonderful efficacy, the num- 
ber of deformities, the result of mal- practice, to be seen in any 
of the populous towns, rather indicates a necessity for the use of 
carnal means. The art of surgery is at a low ebb. Epidemic 
erysipelas of a virulent form is reported to prevail in this Terri- 
tory ; but, thus far, no cases of the disease have fallen under the 
observation of medical officers serving with this army. I have 
reason to believe that ^erysipelas' is a conventional term applied 
to various dissimilar affections, as rheumatism, erythema, anthrax, 
&c.'' — Georgia Med. Sr Surg. Encyclopmdia. 



CANNABIS INDICA AS A HYPNOTIC. 

Dr. FronmuUer, after a large number of experiments, draws 
the following resum^ of the value of this drug : 

<< Of all anesthetics ever proposed, Indian hemp is the one 
which produces a narcotism most closely resembling the natural 
sleep without causing any extraordinary excitement of the ves- 
sels, or any particular suspension of secretions, or without fear 
of a dangerous reaction, and consecutive paralysis. It acts nei- 
ther as violently nor as surely as opium. It can be given in all 
acute inflammatory diseases as well as typhoid affections. It is 
well adapted as an alternate with opium in case this ceases to act. 
Its best mode of administration consists in pills of the alcoholic 
extract and powdered seed. The smallest dose ' susceptible of 
producing sleep is eight grains in pills of one grain. This dose, 
nowever, must be rapidly augmented. The action on the skin, 
the kidneys, and sexual organs, attributed to Indian hemp, is 
without any practical importance. — Jour, qf Materia Medica. — 
J\r. C. Med. Jour. 



DreaimefU of Prostatorrhcea. 278 



Praciical Observations upon the JVature and Treatment of 
Prostatorrhoea. By Professor Gross. 

The disease which I am about to describe, has not, so far as is 
known to me, received any attentioii either from specialists or 
from the authors of general treatises on surgery. The term by 
which it is here designated appears, it is true, in M. I^elaton's 
"Elemens de Pathologic Chirurgicale," but altogether in an inci- 
dental manner, and evidently without any definite idea on the part 
of that distinguished writer as to the true nature of the affection 
in question. 

Prostatorrhoea is, as the name implies, a discharge from the 
prostate gland, generally of a thin, mucous character, dependent 
upon irritation, if not actual inflammation, of the component tis- 
sues of that organ. The reason why the disease has not received 
any specific name or place in surgical nomenclature, is, simply 
because it has always been confounded with other lesions, as gleet, 
or chronic urethritis, seminal losses, and cystorrhoea, or chronic 
inflammation of the mucous membrane of the bladder, from 
which, in fact, it is often diflBcuIt to distinguish it. As for my- 
self, I have long been familiar with the affection, and latterly have 
described it in my lectures at the College. 

I have not met with prostatorrhoea in children or very young 
subjects, probably because all kinds of diseases of the prostate 
are so very rare at that period of life. That it may occur, how- 
ever, even at a very tender age, is altogether likely, especially in 
children laboring under stone in bladder, prolapse of the bowel, 
or worms in the rectum, causing the organ to suffer from reflected 
irritation. After the twentieth year the disease is sufficiently com- 
mon, and instances are occasionally met with even in very old per- 
sons. As long as the prostate gland remains small and inactive, 
or is not brought fully under the influence of the sexual organs, 
with which it is so intimately associated, it is comparatively in- 
frequent. 

1 am not able to say, from my inexperience, what classes of 
persons are most liable to suffer from this affection ; but it has 
seemed Co me that it is most frequent in those of asanguineo- 
nervous temperament, with strong sexual propensities, leading to 
the frequent indulgence of the venereal appetite, if not to positive 
venereal excesses, either in the natural manner or by masturba- 
tion. An irritation would thus seem to be established in the pros- 
tate gland, attended with more or less discharge of its peculiar 
secretion, either in a normal or abnormal state. Single and mar- 
ried men are, appparently, prone to it. Once established, it is 
probable that certain occupations may serve to keep it up ; and it 
is also likely that there are certain employments which may pre- 
Vol. XIX.— 18 



274 Treatment of Prostatorrhwa. 

dispose to it, although it would require a much longer experience 
than is possessed by any one individual to point them out in a def- 
inite and satisfactory manner. Intemperance in eating and drink- 
ing, frequent horseback exercise, sexual abuse, disease of the 
bladder, anus, and rectum, may all be regarded aa contributing 
to such a result. 

The exciting causes ot pros tatorrhoea are not always very evi- 
dent. In most cases that have fallen under my observation, the 
affection was traceable, either directly or indirectly, to venereal ex- 
cesses, chronic inflammation of the neck of the bladder, stricture 
of the urethra, or disease of some kind or other of this canal. 
In some cases it has its origin in disorder of the lower bowel, as 
haemorrhoids, prolapse, fissure, fistula, ascarides, or the lodgment 
of some foreign body. It is easy to conceive how reflected irritation 
might produce this disease. The connection between the prostate 
gland and anorectal region is very close and intimate, and hence, 
whatever affects the one will almost be sure, in time, to implicate 
the other, either in consequence of the proximity of structure, or 
as an effect of the laws of sympathy. However this may be, no 
judicious surgeon ever omits to examine those parts most thoroughly, 
in the event of any serious disease of any of them, before he at- 
tempts a course of treatment. Temporary prostatorrhoea is oc- 
casionally excited by the exhibition of internal remedies, as dras- 
tic cathartics, cantharides, and spirits of turpentine; or, in short, 
whatever has a tendency to invite preternatural afflux of blood to 
the prostate gland and neck of the bladder, or to the posterior 
portion of the urethra. Another cause of the disease, and, ac- 
cording to my experience, a very common one, especially in young 
men, is masturbation or self-pollution. Many of the most obsti- 
nate and perplexing cases of it that have come under my notice 
were the direct result of this detestable practice. 

The sjpnptoms of prostatorrhoea are sufficiently characteriatic. 
The most prominent, as already stated, is a discharge of mucus, 
generally perfectly clear and transparent, more or less ropy, and 
of varying quantity, from a few drops to a drachm and upwards, 
in the twenty-four hours. It is seldom that it is puriform, and 
still more rare that it is purulent. When considerable, the flow 
keeps up almost a constant moisture at the orifice of the*urethra, 
and may even make a decided impression upon the patient's linen, 
leaving it wet and stained, somewhat in the same manner as in 
gleet or gonorrhoea, though in a much less marked degree. The 
most copious evacuations of this kind generally occur while the 
patient is at the water closet, engaged in straining, especially if 
the bowels are constipated, or the fecal matter is uncommonly 
hard, or greatly distends the rectum, so as to exert an unusual 
amount of pressure upon the prostate gland. 

The discharge, whether small or large, is often attended with 



Treatmenl of Prostatorrficea. 275 

a peculiar tickling sensation, referred by the patient to the pros- 
tate gland, from which it freqaentlj extends along the whole 
length of the urethra, and even to the head of the penis. In some 
cases, indeed in many, the feeling is of a lascivious, voluptuous, 
or pleasurable nature, not unlike that which accompanies the 
earlier stages of sexual intercourse. Not a few patients expe- 
rience what they call a *' dropping sensation," as if the fluid fell 
from the prostate gland into the urethra. Other anomalous symp- 
toms often present themselves, such as a feeling of weight and fa- 
tigue in the region of the prostate, the anus and rectum, or along 
the perineum, with perhaps more or less uneasiness in voiding urine, 
and a frequent desire to empty the bladder ; some persons are 
troubled with morbid erections, and their sleep is interrupted with 
lascivious dreams. 

It is astonishing how much the patient's mind suffers in this af- 
fection. The discharge, even if ever so insignificant, occasions 
him the greatest possible disquietude ; for at one time he imag- 
ines it is a source of much bodily debility, or that it is productive 
of weakness or soreness in the dorso-lumbar region, especially if 
these symptoms happen to co-exist ; at another, that he is about 
to become impotent, under the delusive idea that the flow is one 
of a seminal character ; an idea not unfrequently haunts him day 
and night, and from which hardly anything can, perhaps, even 
temporarily, divert his attention. His mind, in short, is poisoned, 
and the consequence is that he is incessantly engaged in trying to 
obtain relief, running from one practitioner to another, distrusting 
all, and affording none an opportunity of doing him any good. 
In the worst forms of the affection, his business habits are de- 
stroyed, he becomes morose and dyspeptic, and he literally spends 
his time in watching for the discharge which is the source and 
cause of his terrible suffering. 

The affections with which prostatorrhoea may be confounded are 
the various forms of urethritis, especially gleet or chronic gonor- 
rhoea, discharges of semen, and chronic inflammation of the 
bladder. 

Prom urethritis, whether common or specific, it is generally 
easily distinguished by the history of the case, the nature of the 
discharge, and the attendent local phenomena. In most cases the 
affection comes on gradually, not suddenly, as in gonorrhoea or 
simple inflammation, and without impure connection ; the discharge 
is white or grayish, translucent and ropy, not purulent, opaque, 
and yellowish ; and there is ordinarily no burning or scalding in 
micturition. Moreover, there is seldom any evidence of inflam- 
mation in the urethra or penis. In gleet or chronic urethritis 
the signs of distinction are sometimes more difficult ; but even 
here a satisfactory conclusion may generally be reached by a care- 
ful consideration of the history of the case, and a proper exam- 



276 TreatmefU of Prostatorrhcsa. 

ination of the discharge, which is nearly always more or less puri- 
form, as well as more abundant than in prostatorrhoea. When 
the discbarge oE the urethra is kept up by the presence of a 
stricture, the diagnosis can be determined only by a thorough ex- 
ploration with the bougie. 

Very many patients confound this discharge with a flow of se- 
men ; an idea in which they are often encouraged by their attend- 
ants, in consequence of their ignorance of the nature of the af- 
fection. Much has been said and written respecting diurnal sper- 
matic emissions ; but, according to my experience, these dis- 
charges are chiefly of a prostatic character, the fluid being forced 
out of its appropriate receptacles into the urethra, along which it 
is presently discharged. This delusion will be more likely to take 
hold of the mind if the escape of the fluid be accompanied by a 
sort of pleasurable sensation somewhat similar to that which fol- 
lows a feeble emission. Persons aS'ected with prostatorrhoea will 
often tell us that they have quite a number of such evacuations — 
perhaps as many as six or eight — during the twenty-four hours, 
especially if they are troubled with disease of the ano- rectal re- 
gion, leading to frequent visits to the water closet, or addicted 
to the pleasures of the table, or to inordinate sexual intercourse, 
eventuating in general and local debility. Should the history of 
the case fail to afford the requisite light, it may be promptly sup- 
plied by a microscopic examination of the suspected fluid, semen 
always revealing distinct spermatozoa, whereas the prostatic and 
urethral secretions never afford any such indications. This will be 
the case whether the discharge be taken fresh from the orifice of 
the urethra, or from the stiffened spots left upon the patient's 
linen. 

The characteristic symptom of cystorrhoea, or chronic inflam- 
mation of the bladder, is an inordinate secretion of mucus, asso- 
ciated in nearly all cases with an altered condition of urine, fre- 
quent and difficult micturition, pain in the region of the affected 
organ, as well as in the surrounding parts, and more or less con- 
stitutional disturbance. In prostatorrhoea there may be also more 
or less uneasiness low down in the pelvis, with trouble in voiding 
urine, especially where the prostate is much enlarged, so as to 
cause constant vesical irritation ; but the two disorders are so 
widely different as to render it impossible to confound them. 

The pathohgy of this affection consists in some disorder of the 
prostate gland, especially of its follicular apparatus, leading to 
an inordinate secretion of its peculiar fluid, and to a discharge of 
this fluid along the urethra, at longer or shorter intervals, and in 
greater or less quantity. That this disorder is, at times, of a 
real inflammatory character, would seem extremely probable from 
the nature of the concomitant phenomena, and also from the fact 
that this organ is frequently, if indeed not generally, found to be 



Treatment of Prostatorrhcea. 277 

more or less enlarged and indurated. Nevertheless there are cases, 
and these are by no means uncommon, in which it is, to all ap- 
pearance, either entirely healthy, or so nearly so as to render it 
impracticable, by the most careful exploration, to discover any de- 
parture from the normal standard. The discharge under such cir- 
cumstances seems to be the result solely of a heightened func- 
tional activity, probably connected with, if not directly dependent 
upon, disorder of the seminal vesicles, the urethra, neck of the 
bladder, or recto -anal structures; in other words, upon reflected 
irritation, or, as our professional forefathers would have denomi- 
nated it, sympathetic disturbance. 

^he prognosis of prostatorrhoea is generally favorable, for it 
does not, in itself, present anything grave, being, as just stated, 
not a disease, but merely a symptom of disease, usually slight, 
and therefore easily removable, its obstinacy, however, is often 
very great, and hence the surgeon should always be guarded in 
the expression of his opinion respecting a rapid cure. When the 
mind deeply sympathizes with the local affection, as is so fre- 
quently the case, especially in young men of a nervous, irritable 
temperament, there is no disease which, according to my expe- 
rience, is more difficult of management, or more likely to result in 
vexation or disappointment. 

In the treatment of this affection, one of the first and most 
important objects is to enquire into the nature of the exciting 
cause, and, if possible, to remove it. To set about it in any other 
way would be the climax of absurdity ; for here, as every where 
else, our therapeutic measures must be based upon a rational pa- 
thology, or a full appreciation of the nature and seat of the disease. 
The points which should more especially claim attention, are — 
first, the condition of the prostate and its associate organs ; and, 
secondly, the habits and state of health of the patient. 

The first of these indications is best fulfilled by a thorough ex- 
ploration of the genito-urinary apparatus and of the anus and 
rectum. For this purpose a catheter is employed with a view of 
ascertaining the condition of the urethra, the prostate, and the 
bladder, aided by the finger in the bowel, previously emptied by an 
enema. In this manner the surgeon becomes at once apprised of 
the existence or non-existence of stricture of the urethra, and of 
the presence or absence of morbid sensibility of its mucous mem- 
brane, the size and consistence of the prostate, and the state of 
the urinary reservoir, particularly as to whether there is inflamma- 
tion, stone, hypertrophy, or other lesion. The finger in the rec- 
tum will be of great service, not only in detecting disease in the 
prostate and bladder, but also in this tube itself and in the anus. 
Indeed, without its aid no exploration of these organs could be at 
all satisfactory. If disease of the seminal vesicles exist, it will 



*-"H Treatment of Ptostatorrhaa. 

M«utilly be evinced by tenderness on pressure throagb the wall of 
lht>buwoI, provided the finger is sufficientlj long, or the prostate 
t* not too voluminous. 

The habits of the patient should be particularly inquired into. 
In many of this class they are decidedly lascivious, or marked by 
excessive sexual indulgence, either naturally or in the form of mas- 
turbation, the prostate gland, seminal vesicles, and adjoining 
structures being thus kept in a state of continual excitement 
highly favorable to the production of prostatorrhoea. The nature 
of the patient's diet, his temperament, the state of his health, 
and his mode of life as it regards sleep and exercise, both of mind 
and body, also deserve especial consideration. 

Having ascertained the above facts, or, in other words, having 
made himself perfectly familiar with the local and general condi- 
tion of the patient, the surgeon will be able, in most cases, to in- 
stitute something like a ratipnal mode of treatment. This should 
be directed, as a general rule, partly to the system at large, 
partly to the suffering structures. In many cases the patient is 
weak, or deficient in muscular and digestive power, indicating a 
necessity for tonics, as iron and quinine, a nutritious diet, with a 
glass of generous wine, and gentle exercise in the open air, either 
on foot or in an easy carriage ; riding on horseback oeing scrupu- 
lously avoided, as likely to keep up undue excitment in the parts. 
One of the best preparations of iron is the tincture of chloride, in 
union with tincture of nux vomica, in the proportion of twenty 
drops of the former to ten of the latter, four times a day. If the 
patient be plethoric, he may use with great advantage small doses 
of tartar emetic in the form of the antimonial and saline mixture, 
care being taken not to nauseate. In either case, it is of para- 
mount importance to correct the secretions and to maintain a sol - 
ubie condition of the bowels. Drastic purgatives are of course 
avoided, as they would only tend to perpetuate the mischief. Un- 
less the patient is actually debilitatea, he should rigorously abstain 
from condiments and high-seasoned dishes. 

Among the most important remedies are — first, moderate sexual 
indulgence, as a means of allaying undue excitement of the pros- 
tate and its associate organs ; secondly, cooling and anodyne in- 
jections, or weak solutions of nitrate of silver and laudanum, or, 
what I generally prefer, Goulard's extract and wine of opium, in 
the proportion of from one to two drachms of each to ten ounces 
of water, thrown up forcibly with a large syringe three times a day, 
and retained three or four minutes in the passage. In obstinate 
cs^so$, cautcriiation of the prostatic portion of the urethra, or even 
of the entire length of this tube, may be necessary, the operation 
boiug n>poated once a week. The cold-hip bath should be used 
twice in the twenty- four hours ; the lower bowel should be kept 
cool and empty ; and« it the disease does not gradually yield, 
leeches shoula 6e applied to the perineum and around the anus. 



Editorial. 2T9 

Sachy in a few words, is a brief outline of the treatment which 
I have found most efficacious in this affection. Whatever plan 
may be employed, perseverance and an occasional change of pre- 
scription are indispensable to success. When there is deep mental 
involvement, hardly anything will effect a cure ; or, more correctly 
speaking, it is almost impossible to induce the patient to believe that 
he is well, or that nothing serious is the matter with him. Under 
such circumstances, our chief dependence must be upon traveling 
and an entire change of scene and occupation. If the patient be 
Single, matrimony should be enjoined. — Transactions of the Med- 
ical Society of the State of Pennsylvania^ Ibid, 



PART IV. 

EDITORIAL. 

OUR SUBSCRIPTION LIST. 

Since the commencement of the present volume, in spite of the 
hard times, and the unsettled state of public affairs, very many 
additions have been made to our list of subscribers, and the num- 
ber is constantly on the increase. Still, we have not yet attained 
one fourth the circulation which we desire, and which we ought to 
have, and we therefore beg our friends not to relax in their 
efforts ; but, taking courage from past success, to press forward in 
the good work in which they have been so generously engaged. 

We would remind new subscribers, that our terms are *4n ad- 
vance," and that in order to avail themselves of the minimum 
price, they should remit without delay the price of subscription. 
Those who are in ar^ars for former years, will confer a very 
special favor by promptly paying up, and thus save us the dis- 
agreeable necessity of again reminding them of their delinquency. 
We regret to say that the two first numbers of the present volume 
are nearly exhausted. 



MISSOURI MEDICAL COLLEGE, 

At the Annual Commencement of the Missouri Medical College, 
held in Mercantile Library Hall, B'eb. 28th, 1861, the degree of 



280 EdUorial. 

M.D. was conferred by the Dean of the Faculty on the following 
gentlemen, after which the usual address was delivered by Prof. 
Paddock: 

Kentucky — ^Francis P. Adams, Graves co. 

Missouri — David L. Bassett, St. Louis co.; Joel H. Blake, 
Cedar co.; Howard A. Cooper, St. Louis co.; Wm. C. Day, 
Texas co.; John M. Dunn, Dade co.; Boyle L. Ellett, Franklin 
CO.; Joel H. Farmer, St. Fran9ois co.; Adolphus Greene, Chari- 
ton CO.; Zachariah L Johnston, Monroe co.; Francis M. Johnson, 
Platte CO.; Preston Lyle, St. Louis co.; Wm. A. Ruso, Johnson 
CO.; Alpheus Rains, Lewis co.; Pulaski Smith, St. Louis co.; 
V. N. C. Stephens, St. Clair co.; D. W. Vowles, Marion co.; 
Thomas W. West, St. Louis co.; John L. Whipple, Lawrence 
county. 

Illinois — John T. Bradbury, Brown co.; Leonidas Brockman, 
Brown co.; Charles H. Brookings, Perry co.; Stephen R. Gay, 
Pike CO.; George H. Knapp, Jersey co.; Wm. H. D. Noyes, 
Pike CO.; Hugh Smith, Sangamo co. 

Tennessee — ^Hartwell Stratton, Shelby co. 

•A/ Eundem Degree was conferred on Dr. A. J. Stoner of 
Brown co. , Illinois ; and honorary degrees on Dr. Charles M. 
Cornell of Sacramento, California, and Dr. Wm. Yost of Green- 
ville, Kentucky. 



RESIGNATION. 



On the incoming of the present sectional administration, Dr. 
McPheeters, one of the editors of this journal, promptly resigned 
the post of Physician and Surgeon to the U. S. Marine Hospital 
at this place, a position which he has fiUed^for nearly four years 
and a half. He is succeeded by Dr. Hammer. 



AN ARTICLE FROM A DISTINGUISHED FOREIGN 
SOURCE. 

Through the kindness of Dr. S. Pollak, now in Europe, we 
have received an original memoir, of considerable length, on 
* 'Facial Neuralgia," illustrated by a case, by Dr. Oostanzo Maz- 



Editorial. 281 

zori of Rome, Italy. Tbis article came to hand too late for the 
present issue, but it will appear in onr next number, and we have 
no doubt but that it will prove highly interesting to our readers, 
coming as it does from so distinguished a source. 



AMERICAN MEDICAL ASSOCIATION. 

The fourteenth annual meeting of the American Medical Asso- 
ciation will be held in Metropolitan Hall, city of Chicago, com- 
mencing on the first Tuesday in June next. Each regularly or- 
ganized Medical Society is entitled to send one delegate for every 
ten of its members ; and each Medical College is entitled to two 
delegates. It is desired that the names of delegates should be 
forwarded to the undersigned as soon after their appointment as 
practicable. H. A. JOHNSON, Assist. Secretary. 

[We insert this official notice as we find it, though from the 
present state of the country, we think it extremely doubtful 
whether the Association will assemble at all at the time men- 
tioned. Indeed we think it altogether desirable that the meeting 
should be postponed for one year. Engaged as we unfortu- 
nately are at present, and from all appearances are likely to be for 
some time to come, in a civil war, we doubt whether any number 
of physicians will be disposed to quit their homes for any ordi- 
nary purpose whatever.] 



SAFETY OF ETHER AS AN ANESTHETIC. 

The following circular explains itself. If any of our readers 
are in possession of facts bearing on this subject, they will do 
well to communicate them to some one of the committee : 

Boston, February, 1861. 

The question of the entire immunity from danger which is 
claimed for ansssthesia produced by ether, being still under dis- 
cussion, the Boston Society for Medical Improvement has ap- 
pointed the undersigned a committe ^*to investigate the alleged 
deaths from the inhalation of sulphuric eiher^ and to report 
thereon." 



282 Editorial. 

They would therefore request the medical profession, or any 
person into whose hands this may fall, to commanicate to either 
of them such cases, coming within their own observation, as shall 
serve to this end ; giving the place, time, and circumstances of 
their occurrence, with the mode of inhalation adopted, and, espe- 
cially, information in regard to the following points : 

1st. The kind of ether used, whether pure sulphuric ether, 
chloric ether, or ether combined with chloroform. 

2d. The period after inhalation at which death occurred ; also, 
any other facts which may enable them to form an opinion on the 
subject of their investigations. 

Committee — Richard M. Hodges, M.D., George Hayward, M. 
D., Solomon D. Townsend, M.D., Charles T. Jackson. M.D., J. 
Baxter Upham, M.D. 



ILLINOIS STATE MEDICAL SOCIETY. 

For the benefit of our Illinois readers, we insert the following 
order of exercises to be observed at the next meeting of their 
State Medical Society : 

Order of Arrangements for the Illinois State Medical Society, 
meeting at Jacksonville, commencing Tuesday, May 7th, 
1861, in the Old School Presbyterian Church. 

TUESDAY. 

A. M. 10 o'clock — Business. 

P. M. — Business. 

4 o'clock — Visit the Institution for the Blind. 

WEDNESDAY. 

A. M. — ^Business. 

P. M. 2 o'clock — Dine at the Insane Hospital. 

8 o'clock — President Chambers' Address, at Strawn's Hall. 

THURSDAY. 

A. M. 8-10 — Visit the Institution for the Deaf and Dumb. 
lOJ to 1 — ^Business. 
P. M, — Business. 
Committee of ^irrangements. — D. Prince, H. Jones, 0. M. 
Long, A. McFarland and N. English. 



Medical Miscellany. 283 

CLASSIFICATION AND DIAGNOSIS OF TUMORS. 

We devote a considerable space in the present number to a 
translation from the German of an exceedingly able and inter- 
esting article, by Dr. Billroth, on the above subject, and to which 
we call the attention of our readers. This article was first pub- 
lished in 1869, in the "Deutsche Klinik,'* a German Medical 
Gazette of wide circulation ; a large edition of separate copies 
was also issued, which in a few weeks was completely exhausted. 

The author, well known previously by many extensive investiga- 
tions in pathological histology, and able papers on various sub- 
jects, was at that time first assistant surgeon to the R. Clinical 
Institute at Berlin, in charge of Prof. Langenbeck, and has since 
been appointed Professor of Surgery in the University of Zurich. 
His article on tumors has evidently found great favor with the 
medical public of Europe, and it will, we doubt not, be regarded 
by surgeons everywhere as a standard authority on the subject. 
The translation is by Dr. G. Baumgarten of this city, and will 
be concluded in our next number. 



MEDICAL MISCELLANY. 



Long Incubation of the Vaccine Virus. — A correspondent of 
the Medical and Surgical Reporter writes the following to the 
editor of that journal : " One year and a half ago, I vaccinated 
a little grandchild of mine, six months old. It did not work, and 
the three incisions made rapidly healed up. She has never been 
vaccinated since ; but about five months ago, all three places be- 
came sore, and she had the true vaccine pock. Her father vac- 
cinated several children from her, and it worked well in every 
case. I saw the child last week, and found the well-marked, 
characteristic cicatrices." 

Medical College of Texas. — ^Wehave received the first annual 
circular of this new Medical College, chartered at the last meeting 
of the Texas Legislature, and located at Houston in that State. 
A full corps of professors are announced, and the institution pro- 
poses to go into operation next fall. We see no reason why Texas 
should not have a Medical College, as it is the order of the day to 
multiply such institutions. 



S84 Medical Miscellany. 

Treatmeni of Trichiasis. — ^Dr. Anagnostakis of Athens, 
says the the London Lancet, proposes the following method of 
curling upwards the eyelashes, and consequent relief fof this trou- 
blesome affection. He uses for this purpose a pair of minute curl- 
ing tongs gently heated, and covers the globe of the eye with 
damp paper. This innocent maneuvre is repeated from time to 
time, until the lashes take their normal direction. 

Recovery after the removal of a larp^e piece of Intestine, — 
The following is from a Columbia (S. C. ) paper : On the 4th of 
January, Cornelius Toohey, in a fit of mania-a-potu^ made two 
incisions in his abdomen, and cut off, with his knife, two pieces, 
each about one foot in length, of the smaller intestine. He was 
taken in charge by Dr. J« McF. Gaston, who was assisted by Dr. 
W. C. Freeman. The haggled ends were clipped off, so that near 
three feet of the intestine were taken out. The two ends were 
brought together and sewed with silver wire. The two incisions 
were opened into one by the surgeon, which, after the operation 
upon the intestine, was sewed up also, and the patient carried to 
the poorhouse. Little or no hope was entertained of his recovery, 
but, to the astonishment of all cognizant with the case, he did sur- 
vive, and on the 28th of February walked from the poorhouse to 
the South Citrolina Railroad depot, and went off a well man. 

Obituary Record. — Died in Philadelphia, March 4th, 1861, 
Thomas Harris, M.D., U. S. N., in the 78th year of his age. 
Dr. Harris was for many years chief of the Bureau of Medicine 
and Surgery in the U. S. Navy. He was a most accomplished 
and skillful practitioner and high-minded gentleman, and enjoyed 
the respect and confidence of a very large circle of friends. Also, 
in Philadelphia, March 3d, Dr. William Harris, brother of the 
above, aged 68. 

Secretion of Milk from the right •Axilla. — ^The Berkshire 
Med. Journal quotes the following from the London Lancet : 
A woman, aged thirty- seven, bore her seventh child, and on the 
night of her confinement observed a swelling in the right axilla, 
as large as half an English walnut. It grew no larger, but be- 
came harder, and there was pain down to the elbow. Nearly four 
weeks later it began to discharge milk (as proved by the micro- 
scope) from a single orifice, hardly larger than a sweat-duct. 
No pus was found in the fluid discharged, but it was quite as rich 
in cream as that from the mammae. Seven months later it 
was still the same, discharging enough to keep her linen moist, 
more especially when using the arm. No such phenomenon had 
attended her previous lactations. 



Medical Miscellany, 285 

Resignation of Prof. Meigs, — ^The resignation of Dr. Charles 
D. Meigs, long the popular and able Prof, of Obstetrics in the 
Jefferson Medical College, Phil., is announced at the close of the 
last session of the college. He retires on account of advanced 
age and infirmity. His successor has not yet been appointed. 
Thus, one by one, the veterans of the profession are laid aside— 
but Prof. Meigs will long be held in grateful remembrance on ac- 
count of his valuable teachings and writings. At the close of his 
last course of lectures, which closes his career as a teacher, the 
class presented him with a handsome portrait of himself, as a 
mark of their respect. 

Podophyllen and Leptandrin as Alteratives, — The North 
Am. Med. Cher. Review says : Dr. R. E. Haughten, of Indiana, 
states that, in order to save his patients from the severe efiects of 
calomel, he resolved to try substitutes milder in their operation, 
bat equally efScacious as alteratives. He found that podophylin 
(the active principle of podophyllum peltatum, or May apple), 
combined with leptandrin (the active principle of the leptandria 
Virginica), in the proportion of half a grain of the former to 
three or four grains of the latter, formed a very good and eflS- 
cient alterative, producing no nausea, pain, or other unpleasant 
symptom. It is added that the leptandrin is an excellent altera- 
tive alone, producing augmented biliary secretion, and thus becom- 
ing a valuable adjunct to other remedies in the treatment of 
disease. 

Liberal Prize, — The Emperor of France, it is said, has con- 
tributed ten thousand francs towards a prize, which the Academy 
of Science proposes offering for the best essay on the question of 
the "Reproduction of bone when broken, or crushed by acci- 
dent, &c." 

The Michigan University and Homceopathy again, — The 
Legislature of Michigan at its last session passed an act requiring 
the establishing of a chair of Homoeopathy in the Medical De- 
partment of the State University at Ann Arbor. This is just what 
might have been expected from the Michigan Legislature, all aboli- 
tion as it is. Men whose minds are so thoroughly imbued with one 
of the miserable isms of the day, are apt, nay, are almost cer- 
tain to run into all other absurdities and torn fooleries of the age. 
But fortunately the Legislature are powerless in the matter — the 
constitution of the State having placed the University in all its de- 
partments exclusively under the control of the Board of Regents. 
This same thing was attempted in the same way several years ago, 
but the Board of Regents refused to comply with the mandate of 
the Legislature, having satisfied themselves that homoeopathy is an 
arrant cheat and humbug — and so we hope they will do again. 



286 Medical MisceUany* 

Gebemin in Spermatorrhcza. — A physician writes as follows 
to the Am. Journal of Indigenous Materia Medica : About four 
years ago, I was badly afflicted with Spermatorrhoea, and had 
nearly despaired ol finding relief, for I had tried every plan of 
treatment suggested by my medical friends, under whose care I 
had placed myself. You recollect my conversation with you, and 
your advice to propose to my friends the use oE gelsemin. They 
acceded to your suggestion ; I had taken but four doses before 
the emissions ceased, and by continuing the medicine my appetite 
returned, the peculiar cadaverous hue of my face yielded to a 
more healthy color, and subsequent years have proved, I was 
cured of my disease. As this is a difficult disease to cure*, I men- 
tion this that others may try its virtues. 

Sight and Reason restored by the operation for Cataract. — 
The London Lancet states that M. Bouisson, Professor at Mont- 
pelier, reported to the Academy of Medicine the case of an insane 
patient, aged fifty years, who was brought to the hospital laboring 
under complete dementia and double lenticular Cataract. Couch- 
ing was resorted to for both eyes. Ten days after the operation 
the man said '^I can see," which was the first sensible word he 
had spoken. As the sight improved he became more manageable, 
until six weeks after his entry he was discharged fully capable of 
earning his own livelihood. In reasoning on the case, the Professor 
remarks : ^^ sensation stimulated the mind as electricity stimulates 
nervous action, the patient being at the time favorably situated for 
such impression." The dementia was probably not deeply rooted, 
and the organ of sight being that which affords the most vivid sen- 
sations, the results have been extremely beneficial as to the pa- 
tient's state of mind. 

Tannin Ointment in Vaginitis. — Dr. Foucher recommends that 
incases of simple vaginitis, or superficial inflammation of the neck 
of the uterus, an excellent local application is an ointment com- 
posed of tannin and lard. This may bo smeared over a piece of 
wadding and introduced through a speculum, a thread being at- 
tached to it, so that the patient can remove it herself. This does 
not supersede the use of constitutional remedies as well. 

Belladonna in incontinence of Urine. — The Journal of Materia 
Medica "quotes, from Dr. Hughes, the case of a boy of fourteen, 
in which he gave the one third of a grain of extract of Bella- 
donna twice a day in cinnamon water. The cause was supposed 
to depend on weakness, or paralysis of the sphincter of the blad- 
der. Belladonna here acts as a tonic to the ganglionic system, 
and a deprescent to the cerebro- spinal system. In like cases 
we have derived benefit from an infusion of uva ursi. 



Medico/ Miscellany. 287 

Position a Remedy for Stertorous Breathing. — The Cin- 
cinnati Lancet & Observer states that Mr. Bowels, after repeated 
trials, assures the profession that stertor in apoplexy, etc., is 
immediately relieved by turning the patient well on his side, so 
that the paralysed tongue and velum palati will fall forward and 
the mucus drain away. Very soon, also, the phenomenon of 
partial suflfocation accompanying the stertor will disappear. 

Laudanum an Jlntidote to Strammonium Poison, — ^Dr. 
Emory of Roanoke, Alabama, publishes in the Southern Med. 
& Surg. Jour, the history of a well-marked case of poisoning by 
strammonium seed, in the person of a negro child aged five 
years — in which laudanum in doses of from three to eight drops, 
repeated, acted as a complete antidote, mitigating all the aggra- 
vated symptoms. An emetic and purgative were also adminis- 
tered. 

Iodide of JJmmonia. — According to the Cincinnati Lancet*^ 
Observer, this drug is reputed valuable in all cases where the 
iodide of potassium is indicated, particularly in constitutional 
syphilis. The advantages claimed for it are, its greater accepta- 
bility to the stomach ; its effects are more rapidly produced, and 
the quantity required is less. From two to sixteen grains given 
during the day is all that is required. We are not disposed to 
find fault with the iodide of pot., which in our hands has proved 
itselE in hundreds of cases to be a most invaluable remedy, and 
we are willing to give the new compound a fair trial ; and if what 
is claimed for it be true, so much the better for poor suffering 
humanity. 

JViuralf^ia. — The Pacific Journal has the following : Twenty 
grains of Keith's lupulen, and ten grains of prussiate of iron, 
divided into two powders, and one taken night and morning, 
have cured a large number of cases of this disease. 

The Louisville Medical JV^ws. — We regret to announce the 
discontinuance of our Louisville cotemporary for lack of due sup- 
port. This is a reproach to the profession of Kentucky under 
which they should not suffer themselves to remain. The great 
State of Kentucky should at least be able to support, well, one 
good journal. 

•Another Suspension. — ^The Georgia Medical and Surgical 
Encyclopedia, after an existence of eight months, is compelled to 
suspend for want of patronage sufficient to sustain the enterprise. 
Sic transit gloria mundi. 



288 Medical MisceWmy. 

fForthlessness of Homcsopaiht/. — ^The American Medical 
Times of New York has the following: ^' The Homoeopathic 
College of this city recently held its commencement, on which oc- 
casion the President gave the following significant charge to the 
graduates. We need no other proof of the utter worthlessness of 
the system which these young men are now deemed qualified to 
practice : 

^^You need not stick alone to Homoeopathy; if that will not 
cure, try Allopathy. If Allopathy fails, try Hydropathy; and if 
you are not then successful, adopt Spiritualism, or any other cu- 
rative means that may be at hand.'* 

It is deeply humiliating to add that this Institution has a char- 
ter from the State, and by its diploma places its graduates upon 
the same legal footing as those of our best schools/' 

Pathognomonic Sign of Scarlatina. — ^Dr. Bouchut lays down 
the following simple sign by wich scarlet fever may be distinguish- 
ed from measles, erythema, erysipelas, or any other like disease. 
Pressure made by drawing the back of the nail of the finger, or 
any other hard smooth substance over the part of the skin in 
which the eruption exists will leave a while stripe which will last 
for one or two minutes. Figures may thus be traced he says on 
the skin, the lines of which are conspicuous for their whiteness. 
This is not the case in other eruptive diseases. 

Poisoning by the Internal use of Choloroform. — The Bos- 
ton Journal says : *' A case is related in the American Medical 
Times, in which one ounce of choloroform was swallowed by a 
girl of 18, for the purpose of self-destruction. She fell heavily 
on the floor immediately after taking it. In twenty minutes. Dr. 
Finnel forced down the throat an ounce of powdered ipecac, 
mixed with warm water. In a few minutes she vDmited, then be- 
came gradually comatose, with stertorous breathing, feeble and 
rapid pulse, and contracted pupils. Mustard was applied to the 
extremities, cold water dashed in the face, with flagellation at short 
intervals. Consciousness began to return in half an hour, and in 
three hours she had entirely recovered. 

Fracture of the Patella successfully treated by Malgaine^s 
Hooks. — Dr. Packard of Philadelphia reports, in the American 
Journal of Med. Sciences, a successful case of transverse fracture 
of the patella treated by the application of Malgaine's hooks. A 
perfect bony union took place after the hooks had been applied 
thirty-one days, the patient suffering comparatively little incon- 
venience from the application of hooks. This is probably the 
first successful case of the kind which has been reported in this 
country. 



THE ST. LOUIS 

MEDICAL AND SURGICAL JOURNAL. 

Vol. XIX. JULY, 1861. No. 4. 

PART I.— ORIGINAL COMMUNICATIONS. 

ARTICLE I. 

A Memoir on Facial JVeuralgia^ illustrated by a ease affect' 
ing the Sub- orbital ^erve. Cured by Excision — wUh 
Observations thereon. By Dr. Costanzo Mazzoni ofRome^ 
Italy. 

It may seem, at first sight, to manj practitioners an idle and 
aimless task to select in our times « as a subject for an original 
paper, a malady described with sach power and effect, and in 
snch truthful colors, by modern writers, especially by YalleiXf 
Martinet, Wencourt, and others. It may seem vain to adduce 
an exposition of a curative method proposed and adopted even 
by the surgeons of the last century.* 

And, in truth, if in perusing the pages of the great treatise, 
writers on neuralgia — if on examining the results obtained by 
the ablest surgeons by means of the excision of the nervous 

* In 1763 Viellard undertook to discofs before the Medical Faculty of Parle, 
a tbeeie conceived as follows : '' Utruoi in fortioribae capitli et faciei dolorlbnt 
aliqoid prodasfe posiit sectio ramorum quioti Parii.^' 

Vol. XIX — ^19 



290 Memoir on Facial JViuralgia. 

branches attacked by the nervoas affection^ I had discovered a 
concurrence of opinion regarding the character, nature, and 
causes of the neuralgia — an unanimous consent regarding the ex- 
cision of the nerve affected in cases of rebellious and obstinate 
neuralgia, and a successful result at least in the majority of 
oases ; I should not have thrown away to no purpose that time 
which would have been more profitably employed in other research- 
es. But to whatever department of medico-surgical lore I direct 
my attention, even though it be a subject of the clearest and sim- 
plest kind, I everywhere encounter discrepancies of opinion and 
oontradictory decisions, sustained on both sides by men of the 
first distinction and talent. Hence it is, that at every step, at 
every turn, no matter on what subject, we are ever constrained to 
make further investigations, fresh observations and fresh experi- 
ments; and where we deem that we have before us a subject 
which, in our estimation, is clear and demonstrably evident, and 
which the mind skims over with assured glances, perhaps at that 
very moment our quick and erring mind hovers over what is false ; 
for sad experience has too often proved that beneath the veil of 
the greatest clearness and simplicity the false and absurd lie 
concealed. The diathetic doctrine, which has for some time back 
so bewitched the minds of the faculty, and quite infected, fasci- 
nated and drawn into error the medical republic, under the falla- 
cious and phantom shape of clearness, simplicity and easy appli- 
cation, revealed at bottom a whimsical hypothesis and an absurd 
principle. And, therefore, as Bonnet justly observes, it is our 
present destiny to behold only the outer surface of creatures, to 
clamber from fact to fact, to analyze and compare these facts, 
and deduce therefrom a few results, more or less immediate, (in 
this consists all our science,) so that at every turn we feel the 
vrgent necessity of renewed observations, of repeated experi- 
ments the better to consolidate the principles adopted, and assay 
how the new principles will correspond with facts. To come more 
closely to the purpose, we shall adduce a striking example drawn 
from our present subject. It must be stated that previous to 
the admirable physiological researches of Mueller, Tonget, Chas. 
Bell and Berard, no one entertained a doubt but that the facial 
nerve was the seat of that painful and insufferable affection of 
the face, which Andr^, a surgeon of Versailles, in 1756, denomi- 



Memoir on Facial JSTeuralgia. 291 

Dated ti<MloaIoareQX, and which Fathergill, in 1776, styled the 
prosopalgy.'*' 

If, however, now-a-daj8, (thanks to the rapid progress of 
physiological studies, a never failing source of substantial changes 
and modifications in pathological doctrines,) setting aside the 
appellation of neuralgia of the facial nerve, it is universally 
known that under the denomination of the iic-dottlouretuc and 
of prosopalgy, is meant the painful affection of the various 
not exist a like unanimity on the causes, character, nature, 
branches of the '*' * * * f there does not exist a 
process, and renewal of this affection — as especially all do not 
too highly approve of the too immoderate application of the elec« 
trie theories instituted to explain the spontaneous paroxysms and 
rapid cessation of the pain — there is less accord on the curative 
method, and more particularly on the last expedient of section 
and excision, which, if productive of stupendous results in the 
hands of Yelpeau, Berard, G. Roux and Bonnet, did not meet the 
approval of the immortal Antonio Scarpa, and proved successful 
in the hands of Dclpech Klein of Stutgard. 

As for the rest, the reader will perceive from the sequel of the 
account of our case, of what profitable considerations it may be 
the source. 

At<the close of his forty-fourth year, in the most prosperous 
state of health, Guiseppe Cornia, by trade a blacksmith, of a 
sangui- bilious temperament and robust frame, about five years 
since, one summer morning while rubbing his face, suddenly felt 
in the middle of the furrow which separates the bulge of the nose 



* Painful affection of the face. 

t How much soever Bischoff, Barthold, and Oaedechens, and even F. Bel- 
lingeri blmeelf, have esaayed, hy means of anatomy, to uphold the untenable doc- 
trine of the sensibility proper to the nerve of the seventh pair } the splendid 
practical results of Magendie, Bleecker, Tund, Tonget, Berard and Bell have 
evidently proved the insensibility of the seventh pair, ascribing to the ramifica- 
tions of the inferior muscular and great occipital nerve (Berard) which aaso- 
eiate with the ramifications of facial neuralgia, which from their following pre- 
cisely the course of the facia), seemed even in some measure to weaken the 
doctrine of Bell, which excludes from the neuralgia the potsibility of having 
Its seat in the eeventh pair, designed only for the movements of the faee, and desti- 
tute of sensibility. '^ Aucun fait," (obserrea Valleiz on this subjeet) que la 
B^uralgie ait r^ellemont exists dans le nerf moteur de la face. Lea eat qu'on a 
donnas comm«9 ezemples de n^aralgie du nerf facial, appartieoaent preaqua 
tous b la neuralgia cervieo-oecipitale. (Trait, des N^r. p. 37.) 



292 Memoir on Facial Neuralgia. 

from the right cheek, and precisely corresponding with the sub- 
orbital foramen, an indistinct, slight and transient pain. For 
three consecutive summer seasona, Cornia, whenever he rubbed 
his face for motives of cleanliness, invariably felt the usual pain 
always constant to the same region, but it disappeared at the 
approach of autumn. The case, however, was different in the be- 
ginning of the summer of 1858 ; for one morning he was sud- 
denly seized in the said region by a most acute darting pain, but 
transient as before, which at an instant disappeared with the 
quickness of lightning, and returned at intervals of greater or 
less duration.* This pain, limited in its first period to the point 
whence the superior mascellar nerve issues from the infra- orbital 
cavity, quickly radiates at each return to the corresponding upper 
lip and to the under eye-lid. The spasms excited by the intense 
pain, occasioned by the law of reflex motion, produce a convulsive 
agitation and contraction of the motor muscles of the upper lip 
and of the bulge of the nose, as also a swelling and redness of 
the cheek. The pricking and darting pains, rarer and less acute, 
become more frequent and intense with each return of the attack. 
So that, if at first the acute and darting pains appeared only at 
distant intervals, during which the patient endured no kind of 
pain, there now remained in the centre of the cheek, at the point 
of emergence of tho infra- orbital nerve, a permatnent, contusive 
pain, sometimes inducing a sensation of stupor, heaviness, and a 
light straining — at others, a simple pricking. The pressure 
made with the tip of the finger on this very circumscribed point, 
exasperated the persisting gravitine pain, and rather generally 
awakened the darting pains, the spasmodic strains and the sting- 
ing sensation. The summer passed away, but this year the patient 
awaited in vain the usual cessation or his sufferings, now render- 
ed quite virulent and torturing, so that in the autumn and ensu- 
ing winter the neuralgic access returned, at irregular intervals, 
more acme and painful than before. During a given time, the 
duration of the paroxysm did not exceed two or three hours ; and 
while this lasted — the spasms, likened by our patient now to strain 
iDgs, pricking, and stinging, and now to violent hot sores — re- 

* Cot* quo b«8 described in graphic and energetic terms the rapid develop- 
menl of the acute stinging pains in the neuralgia, wheie be designates them as 
jUtku offmi% (Fu)gura doloids). 



Memoir on Facial JVhiralgia. 298 

curred at every quarter of an hour, or half an hour, the usual 
graviture contusive pain still continuing, in the intervals, not 
only in correspondence with the sub-orbital cavity, but also in 
the midst of the under eyelid, and a circumscribed point of the 
upper lip ; that is, under the corresponding bulge of the nose, ex- 
actly where the common elevator of the bulge of the nose and 
upper lip confounds and mingles its fibres with those of the or- 
bicular of the lips. 

In the winter of 1819, the neuralgia became virulent, the in- 
termitting pain under the usual form of laceration and puncture 
was frequently excited, not only spontaneously without the slight- 
est cause, but, moreover, very frequently returned quite sud- 
denly in consequence of mastication, a yawn, a sneeze, or a word 
spoken, so that those hours which for the generality of mortals 
are a time of solace and repose, were for Cornia most painful 
and troublesome. A series, however, of pains and sufferings, 
unusually severe, awaited our patient in the spring and summer. 
The accesses of neuralgia increased in number, in violence, in 
extent. If at first between one paroxysm and another there in- 
tervened an interval, a respite of four or five days, of a week, 
and sometimes even of some months, they now manifested them- 
selves daily, nay, several times a day, and at every paroxysm 
the darting pains were renewed at intervals so close to each other, 
that sometimes they occurred every minute. As the violence and 
frequency of the attacks increased, so likewise did the extent of 
the neuralgia ; for the stinging pains and tortures ascended the 
right nasal bulge, radiated to the root of the nose, and then to 
the whole corresponding eyebrow. 

I was called on the 1st of July last, for the first time, to 
visit Cornia. He gave me an exact description of the begin- 
ning and course of his complaint, as persons are wont to do who 
who have perceived their malady gradually develop and increase. 
The intervals and respites were at this time very rare and brief, 
wi the accesses followed close on each other, so that at first 
sight, on account of the apparent continuity of the pain, it n:ight 
nearly be mistaken for * * * * *. The pa- 
tieint pointed out four spots as the places whence stinging pains 
originated and circulated, three of which I have noted above : the 
fourth corresponded to the lateral and superior part of the right 



294 Memoir on Facial Neuralgia. 

nostril, a little below the place of insertion of the elevator mus- 
cle common to the bulge of the nose and of the upper lip. In 
fact, on strongly pressing the said points with the tip of the finger 
( where, according to the statement of the patient, there always 
remained after the cessation of the spasms an irksome and con* 
tinuous pain) the acute stinging pains are instantly felt. During 
the accesses a considerable swelling, with redness, was formed 
and a burning heat felt on the whole affected side of the face, 
accompanied by convulsions and spasms of the muscles, photopha- 
lia, pungent and scalding lacrimation, a swelling of the veins, 
redness of the eye, which in the last period of the neuralgia was 
even not unfrequently attacked by spasm (ophthal madia). No 
pain, however, ever arose in the roof of the mouth, the dental 
arches, the * * ♦ *^ temples, or other places. 

Nor did the neuralgia on its appearing ever assume or manifest a 
real periodicality, that is, a determined order of periods in its 
manifestations. As for the rest, during all these excessive pains 
and sufferances, the pulse scarcely beat quick, the breathing was 
calm, and the general nutrition in nowise deteriorated. 

In tracing out the exciting cause of the malady, it was not 
difficult to discover that it had been exposure to moist cold — ^a 
most potent cause of every variety of neuralgia ; for Cornia often 
occupied himself by night in the holy and pious duty of taking 
up in the fields the dead bodies of those luckless peasants whom 
death often overtakes at a distance from their abodes. When 
we reflect that our patient had sought aid for five years from 
almost all the most skilled and accredited physicians and sur- 
geons in Rome, without deriving therefrom the least diminution 
of his complaint, it may easily be imagined that during this time 
he must have almost exhausted the whole series of those remedies 
which the cure for neuralgia can boast : I therefore refrain from 
particularizing them. 

Even the electric puncture which I prescribed had proved un- 
availing ; I therefore determined to have recourse to the last ex- 
pedient—excision. ■ 

Before I adduce the method, adopted, I may be permitted to 
offer a brief topographic sketch of the distribution of the superior 
mascellar branch, after its emerging from the sub-orbital cavity. 
The sub-orbital branches constituting the extremity of the mas- 



Memoir on Facial JViuralgia. 295 

cellar united in a group and reaching the anterior extremity of 
^e infra -orbital canal, diverge from each other at an acdte 
angle, and running out in all directions like so manj radii from 
a common centre, cross and interlace with the corresponding 
fibres of the facial branch, from which crossing or interweaving 
is derived that quadrilateral mailed plexns, called from its posi- 
tion the sub- orbital, and from its form gooseys /oot. To dis- 
cover it, we have only to remove the elevator muscle proper to 
the upper lip and part also of the common elevator. The sub- 
orbital branches in consequence of their direction form three divi- 
sions, which comprehend the nasal, the superior labial, and the 
inferior palpebral. 

The nasal branches spread out on the back « * * 

* ♦ ♦ * of the nasal bulge and on the common 
and traversal elevator muscles of the nose. The superior labial 
or descending branches ramify in the muscles, the skin and the 

* ♦ * * of the upper lip. The inferior palpebral 
or ascending branches, which are slender and not numerous, tra- 
verse the elevator proper to the upper lip to distribute them- 
selves at the skin and at the ♦ * * ♦ of 
the under eyelid, at the pyramidal muscle, ♦ ♦ * ♦ 
and the lachrymal sac. Among these occurred one worthy of very 
particular attention not hitherto considered by any writer on de- 
scriptive and topographical anatomy, which, ascending internally 
and grazing the inferior and interior fibres of the orbicular of 
the eyelids in the neighborhood of the interior angle of the orbit, 
proceeds to anastomatize with the supra-tracleator and the exter- 
nal nasal.* From this branch, at its origin diverges a lesser, 
which, grazing the border of the infra-orbital foramen and bend- 
ing back upon itself in the form of a circle, proceeds upwards 
externally, and thence interiorly and inferiorly, passes under the 
group of labial branches, and spreads out its slender threads to 
the fibres of the common elevator and that proper to the upper 
lip ; it anastomatizes at this point with the superior labial, and 
thus serves as a medium of conjunction between the palpebral 
and labial branches. 

* We here use the word anftstomosis in reference to the union of the fila- 
ments of the various branches, not to the substantial fusion of the nervous 
pulp, as the ancient anatomists pretended. 



296. Memoir on Facial ^/^uralgia. 

In the preparation of the snb-orbitary plezos, it is extremely 
difficult to trace out and discover the aforesaid palpebral branch 
and its ramification ; 1st. Because it descends to a great depth 
and touches the periosteum ; 2d. Because, in passing the sub- 
orbital canal, it diverges, just before emerging, from the other 
branches composing the group of the superior mascellar; thus 
separated, it escapes therefrom and diverges from the inferior 
palpebral or ascending branches. 

This palpebral branch, which from its course may be justly de- 
signated the palpebro- nasal, is not described or illustrated by 
any of the ancient or modern writers on descriptive and topo- 
graphical anatomy. True it is, that Prof. Calori in his anatomi- 
cal drawings has delineated a slender palpebral branch which 
ascending towards the interior angle of the orbit anastomizes with 
a ramification descending from the internal frontal : however, in 
his corresponding description of it, he does not consider it as a 
speciality ; he ranks it among the palpebral group without as- 
signing it any special name, and has not thought of delineating 
or noting the secondary ramification which borders on the infra- 
orbital foramen. '^ Prof. Sappey, in his treatise on descriptive 
anatomy, supplies us with a certain trace of the palpebro -nasal 
nerve, inasmuch as that among the ascending branches of the 
sub -orbital nerves he detects a branch which anastomizes with 
the external nasal : '' Parmi ces rameaux (rameaux ascendants) 
il en est qui se porte en dedans et qui va s'anastomoser avec le 
nasal externe."t He likewise omits giving a description of the 
secondary ramification which environs the sub-orbital foramen, 
and gives but a rude delineation of the course taken by the anas- 
tomatic palpebral branch : hence, we may suppose that neither 
he nor Calori were competent to describe precisely the palpebral 
branch of which we speak, although each of these palpebral 
branches, which stretch out to the pyramidal muscle of the nose, 
to the * "^ * and the lachrymal sac, anastomizes with 
the ramifications of the external nasal and of the sopratrocleator, 

TABLE or THE PLACES AFFECTED. 

Sub Orbital 5 * P^*"* <>' emergence of the superior mascellar from the sub- 
\ orbital cavity. 

Tabial Paloe- ^ ^ Points of the peripheric termination, 
bral Nasal. ' 1 ^ ^^*°* ^^ere the superior mascellar anastomizes with tiie 



Memoir on Facial JViuralgia. 297 

the said branch thns forming one of the many, not single, anas- 
tomoses of the palpebral with the nasal and frontal branches. 
And let us admit, with certain sophistical opponents, the above 
mentioned distinguished anatomists were alone able to trace out 
the branch in question ; jet they must admit with us, that com- 
pared with our illustration their slight delineation is so indistinct, 

so incomplete, as by no means to detract from Dr. the 

merit of the discovery and of its application to surgical practice. 

On recalling to mind the places affected by the neuralgia in 
question, it is evident that the constant pain under the orbit in 

the direction of the first tooth is confined to the point 

whence the superior mascellar nerve emerges from the sub- orbital 
foramen ; the others corrrespond with the points of peripheric 
termination of its divisions. The pain attached in the last stage 
of the neuralgia to the superior and lateral part of the nose, sus- 
ceptible under pressure of awakening the darting pains, confines 
precisely with the peripheric extremity of that ascending branch 
which we have more minutely described in our description of the 
palpebral branches, or more properly ic marks the anastomatic 
point with the ramifications of the interior frontal. | 

We shall now proceed to the operative process : 

The patient being placed in a horizontal position and subjected 
to the inhalement of vapors of chloroform. Dr. Mazzoni, assisted 
by Dr. Tassi and myself, made an incision, which, commencing a 
few lines from the right bulge of the nose, descended outwards aQd 
downwards in an oblique direction to the length of about an inch 

towards the corresponding '• , thus following the natural 

course of the naso-jugal furrow. Having separated the tegu- 
ments and turned the facial vein outwards, I, moreover, sepa- 
rated several arterial threads which obstructed my search for the 
sub-orbital nerve. Thus, after having removed the adipose mat- 
ter by means of a , turned inwards the elevator mus- 
cle of the lip and directed the canine muscle outwards, I at length 
discovered and made an incision thereon about four lines in length. 

The patient, as if by enchantment^ felt himself relieved from 
the excruciating pains by which he was troubled, and under a 
pressure, methodically made in the different points where the 

I See note on preceding page. 



r 



298 Memoir on Facial Neuralgia. 

nerve radiated , he experienced a sensation of torpor, except in 

the of the nose, which still labored under nearly the same 

affection as before. 

This simple fact sufficed to indace me to search out the anas- 
tomatic nerve with renewed resolution, a process which required 
great patience on the part of the patient. In addition to the cut 
already made, I made a slight incision, which, commencing from 
the centre of the former, I carried downwards so as to form an 
inverted ypsilon, and after about twenty minutes of patient scru- 
tiny I found the slender nerve, incised it to the breadth of about 
three lines, whereon the patient was relieved from all his suffer- 
ings, even the of the nose being rendered insensible. 

The operation was performed at 10 o'clock a. m., on the 9th 
of July, 1859. The operation was attended by a complete dis- 
appearance of the neuralgia ; however, a few hours after a series 
of symptoms set in which for some days kept my mind in a state 
of inquietude for fear that the patient should expire in conse- 
quence of a mere accidental complication sufficient in itself to 
occasion the death of any patient whatsoever, whether his dis- 
ease be one which calls for medical or surgical aid, or whether 
the operation has been or is yet to be performed upon him. We 
will here give the circumstances in detail. 

9 o'clock p. M. Irritation, inquietude, depression of mind, 

fever, preceded by cold with full and vibrating pulse ; a 

pain in the place where the skin was incised ; the tongue covered 
with a light- yellowish coating ; sensation of burning in the stom- 
ach. I prescribed a simple iced lemonade, and recommended 
quiet. The patient had a sleepless night; return of fever to- 
wards the ending of night with general perspiration, voiding of a 
scanty red and sedimentous urine. 

10th July, 9 o'clock a. m. The irritation and inquietude con- 
tinue ; the patient complains of a burning sensation at the epi- 
gastrium ; frequent eructations, nausea, tendency to vomit ; vom- 
ituritions, certain tendineous , moderate fever, yellowness 

of the bulbous conjunctiva : ( composed of castor 

oil, 3 ij, common salt and water of mallows) ; slight alvine dis- 
charge of corrupt bilious matter. 

7 o'clock p. M. The and soreness of the wound gain 

strength ; a recurrence of shudderings followed by a burning heat, 



Memoir on Facial JVeura/gia, 299 

herald the increase of fever ; efforts to vomit ; the swelling and 
redness of the cheek which underwent the operation not extraor- 
dinary; (lemonade as before, repetition of the clyster ;) a most 
nnqniet night with insatiable thirst ; perspiration towards morning. 

Jul; 11th, 10 o'clock A. M. Intense violent fever with an in- 
^ describable irritation and moral depression of the patient ; tongae 
covered with a yellowish coating; continued pain at the epigas- 
trium ; frequent vomituritions; the wound, however, is in an ex- 
cellent condition. I detached a pin from the twisted suture, when 
pus of the best quality dropped thereon, but not so much as was 
at all proportioned to the violence of the fever ; for the wound 
even commenced to cicatrize in the upper part ; (drink as before — 
the usual clyster — fomentations of camomile on the epigastrium ; ) 
slight discharge of bilious matter. 

5 o'clock p. M. Accesses of heat alternating with chilliness on 
the back and by cold in the feet ; increase of all the symptoms. 

9 o'clock p. M. The patient i» in a deplorable condition, while 
the wound is in an excellent state, and the cicatrization progresses ; 
an inconsiderable quantity of bilious matter accompanies, from 
time to time, his repeated efforts to vomit ; tongue unclean and 
dry, slightly covered with a subicteric tint; intense burning pain 
and sensation of heaviness in the stomach ; under stomach me- 
teorized ; prostration ; slight drowsiness, interrupted by frequent 
sighing ; a little sobbing ; parched skin ; scanty and red urine, 
'^ * *, with ocraceous sediment, that is, similar to brickdust. 
(Castor oil, 3 ji; sulphate of quinine, grs. xxiv; to be taken in 
various doses as soon as the perspiration sets in. ) I withdrew the 
second pin from the twisted suture. At night copious alvine dis- 
charges of offensive bilious matter ; a general and most profuse 
perspiration ; he begins to take the sulphate. 

12 o'clock, in the morning. A most marked diminution of the 
fever, with large, expansive and undulating pulse, equable decline 
in all the symptoms. The bitterness of the mouth, however, still 
continues — a certain nausea, sense of heaviness and burning in 
the stomach — although sensibly diminished. (Sulphate of qui- 
nine, grs. xii. * * ♦ * * .) 

7 o'clock p. M. A slight heightening of the fever ; a most 
quiet night ; the patient enjoys a long sleep, during which he is 
covered with profuse perspiration. 



800 Memoir on Facial Neuralgia. 

18th. Morning. Perfect cessation of all the symptoms; the 
patient enjoys a great relief ; there remains only a slight indis- 
position of the epigastrium, and a certain griping in the bowels ; 
urine not much inclined to red and almost without sediment. 
(Sulphate of quinine, grs. xviii. ; lemonade.) The cic:itrization 
of the wound progresses ; when pressed there flows from the ^ 
edges a small quantity of plastic lymph. 

14th July. The improvement continues ; the urine still nearer 
to the normal state ; there still remains a certain griping in the 
abdomen. (Watery inFusion of rhubarb, 3 iiij., to be taken in 
spoonfuls during the day. ) 

During the ensuing days the patient gradually regained his 
lost strength, so preyed upon by repeated and violent fits of fever ; 
his appetite also improved ; the ninth day after the operation, 
the wound was completely healed so as to leave scarcely a cica- 
trix behind ; there was no return of the least indisposition ; the 
sensitiveness of his right cheek quite disappeared, and the right 
side of the upper lip was slightly depressed, an inclination due 
to the indispensable incision of some buccal filament of the facial 
nerve designed for the movement of the muscles of the face. 

Considerations, — In truth, it is no pleasing task for any one 
to determine by the excision of the sub-orbital fascia in rebellious 
prosopalgy, the list of the failures and relapses. Wishing for 
the sake of brevity to limit myself to a few examples, I shall 
merely state that Marechal* cut transversely the infra-orbital 
nerve of a female who for several years had been tormented at 
irregular intervals by tic doulereux, but he was unsuccessful ; for 
although the patient slept quietly after the operation for six con- 
secutive hours, the neuralgic paroxysms returned as before. In 
1776, Louisf communicated to the faculty that he had radically 
cured a religious, afi'ected with facial neuralgia, by means of incis- 
ing the sub- orbital nerve ; but that religious, not long after the oper- 
ation, relapsed into his former deplorable state. Sabatier did 
not prove more successful in the execution of this operation than 
did Marechal and Louis. Professor Klein of Stutgard:|: frankly 
confesses his numerous failures, though he of all other surgeons 

• Observations inserted in the work by Andr^ "Sur les maladies de I' urfetre." 

t Gazette de Zant^, n. 33. 

X Joarnal de Gruf et Walther^ t. III., 1822. 



Memoir on Facial JViuraigia. 801 

made the most experiments in this direction. ^^ After the pnbli* 
cation," says he, *^ of the two observations inserted in the jour- 
nal of Siebold, entitled the Ghirone, in the year 1806, I per- 
formed the operation four times more, and the success which 
accompanied it was only a temporary relief to the patients, after 
which the facial neuralgia returned with its usual violence." 
And we see that Prof. Delpech expresses himself on this subject 
with the same candor as Klein*: ^^ On a souvent entrcpris la sec- 
tion du nerf sous-orbitaire, cette operation n'a pres presq' jamais 
en que des succes passag^res." 

In all the arts, and more especially in medicine and surgery, 
it often happens that in a minute and diligent analysis of facts 
we discern, if not all, at least the principal reasons of our mis- 
failures; hence it is that we not unFrequently attribute to the 
teachings of art the defects of the artificer. We often behold the 
rejection of some remedy or some operative method in conse- 
quence of the incipient failures which attend them ; but they are 
afterwards extolled as soon as the errors in the administration, 
the defects and the execution come to light after an accurate and 
searching investigation. And returning to our subject, we think 
we may justly reduce to tl)ree sources the principal causes of. the 
failures and relapses which occur in regard to the operation pro- 
posed for the cure of the tic douloreux. Among the principal 
causes of the failures, the first that presents itself to our consider- 
ation is the quality of the operative process adopted by several 
practitioners, and its final scope. If we take for a subject of 
examination the greater number of cases wherein the * * * 
returned either instantaneously, or after awhile, it will be readily 
observed that the only scope prefixed in the operation was the 
simple incision of the nerve affected, which, if it obstruct the con- 
tinuity of a nervous branch, entails the disadvantage of allowing 
the successive reunion of the nerve incised, and hence it effects 
but a temporary relief ; or else an operative process is fixed on 
which is incapable of attaining to the principal end of neurotomy 
in cases of rebellious ♦ ♦ ♦ . ^y^^^ jg^ simply ex- 
tracting a portion of the cord affected, or, in other words, excision. 
Every one must have learned from his physiological studies that 

*ttar les maladies repuUea Chlrurgicales, t IH. 



302 Memoir on Facial JViuraigia. 

the ♦ * * of the nerves incised can merely conjoin in the 
same manner as the contractile fibres, and thns convey back sen- 
sibility and mobility to the various parts which in consequence of 
the incision were deprived thereof. 

Who has not heard of the admirable experiments made by 
Spallanzani on the aquatic salamander (Iriton), and of Schwan 
on the frog.* But, if, after having undergone the mere section 
of a nerve, it is possible to recover even a marked degree of im- 
pressionability and * * * * from the recon- 
junction of the nervous fibres incised, it is so much the more diffi- 
cult, not to say impossible, for these functions to be again brought 
into play if it happen that a considerable part of the nerve has 
been cut and removed. 

While on this subject, I deem it expedient just to mention the 
experiments performed on some dogs by Prof. Luigi Malagodi, 
the glory of Italian surgery, which he thought proper to effect 
previous to his attempt to free by the excision of the ischiotic 
nerve, in the third inferior of the thigh, a certain Fillippo Sarti 
of Bologna, from an insupportable * * * resident 
in all the ramifications of the said nerve which * * * 
to the leg and feet, an operation so novel in surgery as to acquire 
for the illustrious surgeon no small share of renown. t Nalagodi 
perceived that after ten months the sensibility and mobility again 
awakened in the hind legs of those dogs in treating, which he 
limited himself to dividing transversely the ischiotic nerve by a 
single incision effected on the origin of the two branches, tibial 
and * * * ; vWle, on the contrary, the paralysis contin- 
ued constant and perfect from the middle of the leg to the ex- 
tremity of the toes in those dogs from which he removed any por- 
tion of the nerve. He did not stop at this first experiment; for 
at the end of the tenth month, he put to death all the dogs oper- 
ated on ; on dissecting them he observed that in the former the 
divided * * * were collected in a knot foimed of a 
white substance about the size of a walnut, while in the latter the 



• Descot relates that a man having cut the cuhltal nerve, instantly lost all 
tense of feeling in his fourth and fifth fingers, which he afterwards regained by 
degrees in consequence no doubt of the reconjunction of the two * * ♦ * 
(Bur les affections locales des neifs.) 

t Bologna, 1830. On the incision of the sciatic nerve. 



Memoir on Facial JViuralgia. 808 

knot was seen in both the * * * bound together by an in- 
termediate ligamentous cord, which acted instead of the portion of 
the nerye extracted. Not content with this, he discovered bj 
means of maceration numerous ligaments of a nervous nature, 
which passed from one extremity to the other of the nerves con- 
joined by a single knot * * * the ligamentous cord 
resolved itself into a cellular tissue. Hence, he concluded that 
the safest means to prevent the uniting of the nerve was that of 
withdrawing a sufficient quantity thereof. It being thus estab- 
lished that the simple incision does not prevent the reunion of the 
* * * of the nerve aflfected, why is it to be wondered 
at that in the greater number of instances wherein the majority 
of surgeons have prefixed and still prefix the mere cutting of the 
nerve affected as the final scope of the operation, the * * * 
accesses have been renewed? If, therefore, Marechal, Louis, 
Klein, Sabatier, Delpech, adhered so much to the incision or sec- 
tion of the nerve as well in sub- orbital as in other * * « « 
a want of success must have been a natural consequence thereof. 
^^ Ainsi, Marechal, (writes Valleix'*' ) opera on tenta d' operer la 
section dn nerf (in trifacial * * *) sans aucun succSs: 
des chirurgiens plus modemes ont fait ^galement des tentatives 
infructuenses." Louis, in the aforesaid instance of the religious, 
confined himself, as Pinol testifies, f to the simple section of the 
sub- orbital nerve. **Ihave cut," writes Prof. Klein, "all the 
nervous filaments on one side of the face from the sub-orbital 
cavity at the posterior angle of the lower jaw, effecting the cut 
to such a depth as to touch the bone ; and in one individual I re- 
peated this incision full four times at different intervals, and 
nevertheless he derived therefrom but a temporary and fleeting 
advantage." Delpech, distinctly speaking of the * * * * 
in the various branches of the * * * ^ expresses himself to 
the following effect: '^ On a souvent fait inutilement dans ces 
cas (frontal neuralgia) la section du nerf frontale. On a souvent 
entrepris (in sub-orbital neuralgia) la section du nerf sous- 
orbitaire, cette operation n' a pres qu' jamais en que de succds 
passag^res. Nous avons vu pratiquer a son occasion (inferior 
mascellar neuralgia) mais sans succds, les incisions a 1' interieur 

* Traits de n^aralgies, p. 210. 
t Sttr le tic douloureux de la face. 



804 Memoir on Facial Neuralgia. 

de la face, dans I'intention de divisor ane partie de ce nerf." A 
similar ill success attended those practitioners who adhered to the 
process of Bonnet, that is, to the sub-cutaneous section in the 
cutting of the frontal and sub-orbital nerve (Petrequin). This 
operative process not only excludes the simple incision, but does 
not even guaranty the complete section of the nerve. Finally, a 
like failure, consequent on a similar obstacle, awaited those sur- 
geons who undertook to ascend the sub- orbital nerve from the 
interior part of the mouth, incising to the length of en inch and 
a half the furrow which joins the upper lip to the gums. On 
the contrary, two operations by M. A. Berard, having in view 
the removal of a portion of the nerve were crowned with brilliant 
success.* (Resection d' une partie du nerf.) <^8i I'on ne 
consid^re que 1' anciennet6. (I maybe permitted to quote the 
words of Valleix dictated on the subject of one of Berard's cases:) 
La violence, la gravite de la neuralgic, la prompte disparition des 
douleurs est la solidity de la gu^rison, c'est assur<^.ment la un 
des cas les plus conclusnts que nous possedions." (Tr. des n6a* 
ralgies, p. 212.) The number of successful cases obtained by 
means of excision is now augmented by ours, which if not for its 
antiquity, at least for the violence, the strength of the neuralgia, 
for the prompt disappearance of the pains, is in nowise inferior 
to Bernard's case, quoted by Valleix in the twelfth Obs. ; and 
we are quite assured that it does not yield thereto in the effi- 
ciency of the cure. 

A second source of ill success or of relapses is attributable to 
an imperfect knowledge of the seat of the sub- orbital neuralgia, 
or, to speak more properly ,t to the neglect of not having dis- 
cerned previous to the operation the limits of the neuralgia, inas- 
much as from the greater or less extent of this we must obtain 
the indication or counter- indication of the excision to be made. 
And, indeed, the pain is in some instances confined to the cutane- 
ous branches of the superior mascellar vein or to the sub -orbital 
branches; in others, only the anterior- superior alveole- dentar 
branches are affected by the neuralgia; in others, again, it pro- 

* Observations recueillies par M. Godin. Journal de Conn. Med. Cbir. Mai, 
1836, p. 442. 

t What we here say of the reat of the sub-orbital neuralgia, is referabl* 
also to all the neuralgiat coming under surgical operation. 



Ob^eirzcai Manual. 805 

pagatea itself to the whole dental arch, to the body oE the tipper 
jaw, to the palate, the malar bone, the corresponding temple, 
and to the interior of the ear, following the coarse of the dentary 
branches, of the orbital branch and its malar and temporal rami- 
fications and of the great superficial ♦ * ♦ * nerve. 
It is evident, that in the first mentioned case, wherein the pain is 
limited only to the cutaneous branches, the re-section of the sub- 
orbital foramen will be sufficient and indicated ; every operation, 
however, will prove wanting and unavailing in cases wherein the 
neuralgia mounts to the branches which diverge at some depth 
from the branch in the fossa speno-mascellaris, which indicates 
that the complaint extends even to the origin of the nervous 
branch. When in this case we essay to excise the nerve at its 
point of emergence from the sub-orbital foramen, the pain will 
continue, nay, it will attain greater virulence in the other places. 
In order to efi'ect a certain cure it would be requisite to extend 
the cut as far as the round foramen of the great ala sfenoidea; 
which no surgeon would even think of performing. IE the ante- 
rior alveolo-dentary ligaments be alone affected by the neuralgia, 
it is then requisite in order to be secure of success to follow the 
rule and counsel oE Malgaigne and excise the nerve in its own 
channel : an operation which is extremely difficult. One thing is 
indispensable, and that is an accurate examination oE the seat 
oE the neuralgia previous to undertaking any kind oE manipula- 
tion. After this remark, we shall be no longer surprised iE sev- 
eral surgeons have found that, even after the excision oE the sub- 
orbital fascia, the neuralgic pain still adhered to the dentary 
arches, to the * * * and to the os mascellaris. 
ITo be Continued.'^ 



Obstetrical Manual. — ^Prof. D. Warren Brickell of New Or- 
leans proposes to issue on the first day of January of each year, 
a volume of 400 to 600 pages, devoted exclusively to obstetrics 
and the diseases of women. It will consist of a liberal expos6 of 
every thing new in relation to these important branches of medi- 
cine, as no pains or expense will be spared to extend inquiries into 
every field. Subscription price, payable invariably in advanoe, 
four dollars per annum, or fifteen dollars for four sabseribers. 
Vol. XIX— 20 



806 Foreign Correspondence. 

ARTICLE II. 

For the St. Louis Medical J6iinial. 

LETTER FROM(dR. S. POLLAK.] 

Paris, March^ 1^861. 

I beg leave to deviate for a moment from my itiDerancj to 
and through some of the hospitals of Paris, in order to say a 
few words about the '*Acad6mie de Medicine" of Paris. The 
transactions there, always of great importance, were even more 
so lately, for reasons which I will endeavor to enumerate. Think 
not that I will attempt to give even a simple outline of the say- 
ings and doings there ; the *' Bulletin of the Academy" does not 
in truth do justice to them. I will only state a few facts which 
may be of interest to you. 

Scientific and learned associations have existed in France for 
centuries; they were independent of all government patronage 
and interference. Colbert^ the great Minister of Louis XIV., 
was the first who acknowledged their importance, took them un- 
der his especial care, and endowed them largely. On the 22d of 
August, 1796, the *' Republic of France" united them all, under 
the name of ^'Institut of France," a name which it has ever 
since maintained. It was divided into many distinct academies, 
which have changed with nearly every existing government; the 
last or rather the present are the five following : 

1. L*Aoad^mie Fran9aise. 

2. L' Academic des Inscriptions et Belles -Lettres. 

3. L'Acad^mie des Sciences. 

4. L'Acad^mie des Beaux-Arts. 

5. L'Acad^mie des Sciences morales et politiques. 

The Academy of Science is divided into eleven sections, one 
of which is the section of Medicine and Surgery, Conse- 
quently our profession occupies as yet a very subordinate posi- 
tion in the Institut of France. As such it meets in the building 
of the Institut, and its transactions are published by the Institnt. 
Conscious of deserving a more elevated and independent position, 
another and wholly independent Academic de Medicine has been 



Foreign Correspondence. 807 

formed, which it is expected will soon be incorporated with the 
Institut of France, but as a separate division. 

The Academic de Medicine owns its own building in the rue de 
Saints P^res, and holds its meetiogs every Tuesday afternoon 
from 8 to 6 o'clock. 

The Academic de Medicine can only have one hundred mem- 
bers, and no more. Vacancies by death or resignations are 
filled by coneours. It is the highest professional honor to be 
elected a member. Hence, only the oldest and the most distin- 
guished men in the profession belong to it; but hundreds not 
members attend the meetings. The room is not large, and so 
densely crowded, that it is always filled an hour before the ses- 
sion begins. The members as they enter register their names 
on a sheet of paper. Punctual to a second, the President t^kes 
bis seat, draws a score under the last name and signs it. None 
can be registered under the President's name. All who come in 
after that, are only entitled to their seats, but excluded from 
participating in the debates or voting, and are fined, besides, fifty 
sous. Tou can imagine how few are found absent at the open- 
ing oE the session. The Academic is subdivided in the following 
sections : 

1 Section — Anatomic et physiologic. 



2 




Pathologic m6dicale. 


8 




Pathologie chirurgicale. 


4 




Th6rapeutique, et histoire naturelle m6dicale. 


6 




Medicine operative. 


6 




Anatomic pathologique. 


7 




Accoachements. 


8 




Hygiene publique, medicine legale et police 
m6dicale. 


9 




Medicine v6t6rinaire. 


10 




Physique et chemie m^dicale. 


11 




Pharmacie. 



The members are distributed in these sections, and no member 
can belong to more than one. In the section of Physiologic, 
there was no vacancy for seventeen years, and not until the 5th 
of March, 1861, has the great and distinguished physiologist, 
Claude Bernard^ the man of the times and the pride of France, 
been elected a member, to succeed Mr. Dumeril, lately deceased. 



808 Foreign Correspondence. 

Of coarse, his election was Qnanimoiis ; bnt asnally there is maoh 
canvassing, log-rolling, and intriguing going on, almost eqaal to 
the United States. Rohinet is the President this year ; BouiU 
laudy Vice President ; Robin, Secretary. I attended the meet* 
ings as often as I could, and will relate a few incidents. 

Jobert exhibited a ball, which struck the forehead, penetrated 
the bone, and was stopped by the dura mater, of which it only 
caused a slight inflammation. Mr. Juies Cloquei, the retiring 
president, said that the ball was caught by the vieihre of the 
schaka, and struck only by ricochetting. He mentioned the 
celebrated duel between Mar6chal Bugeaud and Monsieur Dulong. 
The ball which struck and killed the latter, separated in two 
pieces on entering the head, each piece running round the fron- 
tal,« parietal bones, and sank deep in the occiput. 

The Academic de Medicine offers annually a prize of 3,000 
francs for the best essay on a given subject. The thesis of this 
year is: the subperiostal regenercUionj or reproduction, in 
fractures produced by projectiles or other causes. 

Already, in 1847, Mens. P. Fiourens, the perpetual secre* 
^ary of the Academic des Sciences, published a series of experi- 
ments, instituted by himself and Duhamel on the following pro- 
positions : 

1. Bone or callus is formed in, and by, the periosteum only. 

2. The growth of the bone in thickness is effected by super- 
posed layers. 

3. The growth of the bone in length hy juxtaposed layers. 

4. The medullary canal is produced by the resorption of 
the internal layers of bone. 

5. The heads of the bones are successively formed and r«. 
sorbed, in order to be formed again, as long as the bone grows. 

6. This constant mutation of matter is the great and mar- 
vellous spring or source of bony development. These were the 
mechanical experiments, abundantly and successfully illustrated 
by numerous drawings and osteological specimens. 

Then he tried, and satisfactorily proved, the identity of the 
medullary membrane and of the periosteum, by the following 
propositions : 

1. The medullary membrane is the organ which resotbs the 
internal layers of bone. 



Fore^in Correspondence. 809 

f 
2. The medullary membrane produces bone as well as the 
periosteum. 

8. The perioBteum resorbs the bonp as well as the medullary 
membrane. 

4. In certain cases^ the periosteum produces and forms the 
medullary membrane. 

5. The medullary membrane and i)iQ periosteum are actually 
one and the same organ. 

The production of callus is subject to the same laws as the 
production of the whole bone. 

He then tried to prove the marvellous faculty the bones possess 
of reproducing themselves — thus : ' 

1. The periosteum reproduces and returns all the portions 
of the bone which had been taken from it. 

2. That even the periosteum might be destroyed, and it will 
reproduce itself and then reproduce the bone. 

Then he exhibited numerous specimens of osteology, both of 
mammiferous animals and birds, with the experiments which he 
made by means of madder. The immense auditory sat breath- 
less, and listened to this learned man. He is very aged, and of 
course cannot continue the experiments much longer ; and he 
proposed that it be made the subject of the prize essay for 1861 ; 
that five years' time be given to the essayists to hand in the re- 
sults of their labors ; that the prize be 5,000 francs, instead of 
8,000 francs, as usual. Mar6chal Faillant, the distinguished Min- 
ister of War, was present, who is quite a scientific and industrious 
man. He arose and said, ^^ the subject of subperiostal regenera- 
tion of bone or callus is all -important for the army. Many a 
brave soldier might be reclaimed, even after receiving severe 
osseous injury, if the subject were well and generally understood. 
Amputations might be less, and entire recoveries more frequent. 
I beg you to add 5,000 francs more for the prize, in behalf of 
the government.'' This was received with rapturous applause. 
The same evening, Mar^chal Yaillant was at the Tuilleries. In 
conversation with the Emperor^ he stated -to him the important 
labors which the Academy of Medicine was engaged in. The Em* 
peror at once added 10,000 francs of his private purse to the 
prize on the above subject. This is now 20,000 francs, besides 
immortal honor, and fame, and gratitude of nations present and 



810 Foreign Correspondence. 

to come. Will not some of oar ambitions St. Lonisians try it ? 
Prizes were received there on optical theses, which were new and 
less known snbjects, on a six months' notice; why not try this? 
Five years and 20,000 francs ought to be enough. 

There are other medical Societies in Paris, independent of each 
other, which hold regular weekly meetings, always in the day 
time. The number of members is limited, and only elective on 
furnishing an original thesis on any subject. It takes several 
years before an applicant for membership can take a seat. 
They allliave poor rooms, but good libraries. The transactions 
are minutely published in the numerous medical journals. They 
are worth publishing indeed. For only the ablest men are elected, 
and they are strictly kept to the rules, and time of speaking. 
They speak to the point, waste no words. Of course, a person- 
ality is never thought of, no matter how great the difference of 
opinion. Thus, M. Trousseau, who is watched with argus eyes, 
lately propagated some new theories on the subject of Apoplexy, 
and calls a frequently occurring disease rheumatismal apopkxy. 
In his lectures, in his forthcoming new work, and in the Acad- 
emy, he launched out his new ^* really theoretical'^ ideas — ^he is 
more ideal than practical. At once, he was pounced upon by all 
the psychiatrists of the day. Only Fabrety Delasiauve^ Bouil- 
laudy Baillargerj GrisoUe^ have spoken; at least twenty more 
are on the list ; they will all have their turn. After every speech 
Trousseau gets up, shakes hands with them, and embraces them, 
though they are a// his opponents — just as in St. Louis :(?) 
The Psychological Society meets every Monday. 

** Medical Society (or Academy) ** Tuesday. 

" Chirurgical . . . . " Wednesday. 

** Obstetrical .•..** Thursday. 

" Ophthalmological . . . " Friday. 

" Biological . . . . ** Saturday. 

They are all interesting and instructive in the highest degree. 

The •American Medical Society is defunct long ago — cause, 
want of interest, want of money, want of every thing. An alli- 
ance with the German Med. Soc. was proposed, but declined. 
They presented their small and dilapidated library to the ^cole de 
M6dicine. Very few Americans attend the meetings of the dif- 
ferent Academies, and justly so ; for there is not one in twenty 



Foreign CorreJipandenee* 811 

who anderstandfl the language* It is a yery great mistake for 
American students or physicians to come here before they learn 
French. Bat more of this hereafter. 

I will return to my itinerancy to and through the Hospitals of 
Paris, and commence with the Hopiial Beattjony 440 beds ; for 
maleSy234; for females, 206; for medical, 262; for surgical 
cases, 178. The Physicians are Behier^ Oubkr^ Fremy^ 
Montard- Martin ; the Surgeons are Huguier and Gosseiin; 
the latter quite a celebrity, his chirurgical genius haying been in- 
herited from his father. 

Beaujon is a beautiful hospital ; the system of pavillions united 
by a covered gallery is here observed, as in the Lariboisi^re. It 
is well kept and has a very active service. I was glad to meet 
with two young American physicians of New York as eztemes 
there — ^which is, in fact, the only possible way for young physi- 
cians to learn something here. The physicians go through their 
visits quite mechanically, without spirit or good will. It is so- 
porific in the extreme. But GosseHn is a wide-awake, driving 
man, a bold, skillful surgeon, a courteous gentleman ; likes to 
see visitors, and takes all pains to make a visit profitable. He 
will consult visitors, and frequently adopt their suggestions^ which 
Parisian surgeons are not apt to do. 

An extirpation of an encephaloid tumor of the neck by means 
of sixty- four caustic ^dcAe« terminated fatally on the third day. 
Here also is erysipelas, the bane of the surgeon, though not as 
much as in many other hospitals I saw, owing to a rigid cleanii* 
ness and a freer ventilation. Ventilation, or rather a draught of 
air, is the bugbear of the French. In hospitals and in private 
houses they hardly ever open a window. The surgeons insist 
that a current of air will bring on tetanus. My observation, that 
it IS just as well to die of tetanus, which is an extremely rare 
occurrence, as to die of erysipelas, which is a tri-daity event, 
was not well received by the old surgeons, but quite coincided in 
by the younger ones. 

They dare not perform here many capital operations owing to 
the fatal result consequent on the supervention of erysipelas, 
which in these crowded, illy ventilated hospitals is inevitable. 
Many patients having acute eruptive diseases are mixed with the 
others, though the terrible effect is daily manifest. 



812 Foreign Correspondence. 

Tk«re is scarcely s medical ward in the Parisian hospitals without 
eases of small-pox in it. In Trousseaa's ward there are nine in 
one room. If a person is well vaccinated it is all they enquire 
after. In the different salks des nourriceSy mothers and in- 
fants are alike taken with small-pox. Vaccination and revacci- 
nation is rigidly and regularly practised, bat not always with the 
desired effect. Vaccina and variola go through their different 
phases simultaneously without much influencing each other's 
characteristics. The disquisitions and discourses of the chefs 
de clinique are learned and interesting, but they never yet 
proposed the only remedy in such cases: the separation and iso- 
lation of small- pox cases from other patients and from contact 
with the community. 

I have made inquiries at the Beaujon about the official service 
of the homoeopathist, M. Tessier, who was there five years. I 
had the promise the necessary information would be given me. 
It required much time and labor to examine the journals. When 
I called again, I received a polite note from M. Husson, the 
director general of all the hospitals, excusing himself for noi 
allowing such examinations to he made. He said : to examine 
the journals is a labor of several weeks, which he is not willing to 
allow to be made without an especial order from the govern- 
ment. This order would not be given without first conferring 
with the Faculty of Medicine, and the latter would doubtless ob- 
ject to it. And, unless he gives me the necessary information 
authoritatively and officially, it would not be credited. Hence, he 
reasonably concluded not to give me any. He simply added, ver- 
bally, ^'Homoeopathy is not recognized by the government." Mr. 
Tessier received his appointment by concours, as well as any other 
chief. Once appointed, he is autocrat of his ward. None has a 
right to question his mode of treatment. Tessier received the 
first appointment in 1839, and has been in service ever since. 
His success is about the same as the others, but whether he strictly 
homoeopathized he does not know. Certain it is. that his orders 
for cod- liver oil, quinine, wine of quinquina, iron, and saline 
purgatives, are just as large as those of any other service. 

The Hopital Oochin is the smallest of all the hospitals of 
Paris. It has only 125 beds, is under the charge of de Saini 
Laurent as physician, and Desormeaux as surgeon. It would 



Foreign Correspondence. 818 

hardly attract attention bat for the ingennity whioh the latter is 
imagined to possess in inventing new scopes^ which he calls 
urethroscope and endoscope. This is the age of scopes. We 
have got now a stethoscope^ r ecto scope ^ vagina-scope y auro or 
otoscope^ ophthalmoscope y laryngoscope. The last two, com- 
paratively modern ; the French, envious of Helmholz and Czer^ 
tnacky for the invention of the last two instraments, taxed their 
ingenuity, and gave birth to an abortion. Desormeauz's ure^* 
throscope is nothing but a voluminous clumsy catheter of metal, 
with a cleft on one side, so as to permit the introduction of a stilet, 
or of caustics. To the outer end is attached an illuminating ap- 
paratus, which throws a few feeble rays, through this catheter, to 
the inner end, where a very small portion of the interior surface 
of the urethra may be seen. It is just as clumsy as useless, and 
as costly as ridiculous. But he goes still further, elongates this 
catheter an inch or two, bends it at an obtuse angle, and here is 
a small glass window, through which the light is thrown into the 
interior of the bladder. Of coarse the bladder must be filled. 
He pretends that he never fails to see a calculus without feeling 
it. This lantern of the bladder is even more ridiculous than the 
urethroscope. The introduction is excessively painful; the in- 
strument very costly. The illuminating apparatus alone cost 800 
francs. He will find none to contest the priority of invention. 
He is welcome to all the glory and fame of it. He is otherwise 
a good surgeon, an amiable man, and took it kindly when I 
called it the lantern of the bladder. 

HdpUal du Val-de-Grdce is a military school and hospital. 
Only graduates are admitted as students, where military medi- 
cine and surgery are practically taught. I regard it as by far 
the best school in Paris, superior in every respect to all the 
others. Admission is diflScalt to obtain, and at the best is very 
limited. It is under the charge of a large corps of teachers, 
who are known both for their bravery and skill. They all lec- 
ture and hold clinics in their uniform, and are abundantly deco- 
rated. The students also are in their rich uniform. There is no 
crowding around the bed, but all can see and hear well. It is 
delightful to see the order, neatness, and quietude predominating 
there. I will enumerate the names of the Professors, and the 



814 Foreign Correspondence. 

subjects they teaoh; for it is entirely different from any other 
medical school : 
Director — Michael Levy. 

Professors: Clinical Medicine — Godelier. 

Clinical Surgery — Legoueat. 

Epidemics and Diseases of Armies — Laveran. 

Operations and Surgical Apparatus — Lusterman. 

Hygiene, Legal Military Medicine, and Administra- 
tive Rules — Champouillan. 

Toxicological Manipulations and Chemistry, applied 
to Hygiene — Coulier. 
There are besides the following agr6g6 Professors — Lallemand, 
Trudeau, Baizeau, Desgardins, Cohn, Perrin, and Boussin. 

Nothing can exceed the dexterity and skill with which operations 
are performed, and wounds and injuries dressed. It is no wonder 
that the French are so far ahead of any other nation in their ^eld 
medical appointments and arrangements. Nothing is wanting, 
every thing has its place, every thing is abundant, nice, tidy and 
compact. They have to go through the regular exercises of 
packing and unpacking all the equipments appertaining to an 
ambulating hospital, within an incredible short time. A hospital 
put up, and again struck and snugly stored away, did not take 
twelve minutes. I would have rather attended regularly here 
than at any other hospital in Paris. But my permission was only 
for three days. However, I learned many practical hints, which 
I will try to remember when required. This, and the little mili- 
tary surgery I saw in Naples, is to me invaluable. It is not 
read about, it is not taught, it must be seen. If a war breaks 
out, before I leave Europe I will try to take a few more practi- 
cal lessons. The courtesy and politeness of the Professors at 
Val-de-Grace will be always remembered with gratitude, espe- 
iJAlly Monsieur Oodelier and Mens. Legouesi, 

The ^siles imperiales de Vincennes and Vesinei, — These 
are two large and new institutions unlike any other in tde world. 
They are maisons de convalescence^ or houses for convalescent 
patients — ^Vincennes for males, 420 beds ; and Vesinet for females, 
320 beds. They are about ten miles apart, occupying extensive 
richly improved grounds and presenting a palatial appearance. 



^0 



9cing 
•re- y 



Foreign Correspondence* 816 

abonnding not only with comforts but Inxnries, sizch ae were 
never known in institutions of charity before. They are both crea* 
tions of the present Emperor. Yincennes was opened in 1856, 
Yesinet in '59 ; and are intended for the reception of convalescing 
patients fr^m all the hospitals of Paris, which are so crowded, 
that a patient, if he recovers, cannot possibly fully recuperate 
there. They are^nt out for twenty days to these two houses, 
where the delightful air in the country, the healthy diet, and other 
accessories, never fail to restore them to activity and usefulness. "]fi 

Everything which science, common sense, and experience could 
suggest to render these two hospital institutions true convalescing 
places, has been done. Never have institutions shown better 
suits than these, and they ought to be imitated in every country. 
Few patients can regain their wonted strength in a crowded hospi* 
tal ; and if sent out too soon, and compelled to work for a living, \ 
they soon must come back, or succumb. / 

But these two convalescing asylums present a beautiful but 
severe criticism on Parisian practice of both medicine and sur- 
gery, especially the latter. Over 1800 cases of fractures were 
admitted in 1860, in Yincennes, and never, I aver, were such 
awful results known before. I exempt no hospital of Paris ; they 
came from all. But so many shortened and distorted limbs are 
unpardonable. The Parisian surgeons are quick and very good 
at cutting, but are very poor bone-setters. Marjolin, in St. 
Eugenie, is yet the most successful ; but as to the rest, they are 
shocking. No surgeon could maintain himself with us with such 
results. Whether the vitiated air of the Paris hospitals is the 
cause of it is not for me to say. Of course I have no knowledge 
how they succeed in private practice. 

One more hospital I have to mention, which is Bicelre^ of 
8,400 beds, under the charge of Leger ; Voisiriy MoreaUy and 
Belastauvcy physicians for the insane ; the latter having par- 
ticular care of the idiots, epileptics, and paralytics. This im- 
rkeuse establishment is absolutely unworthy of Paris, badly kept, 
dirty and filthy. It is at once seen that the Sisters of one or 
the other religious order have no hand in it. It was once a 
Caserne, it is now a hospital, and ought to be abolished. It is 
uninteresting, except the department of the idiots, which they en- 
deavor to reclaim by means of gymnastics, and suitable mental 



816 Foreign Correspondence, 

(?) exercises. Thej are far behind those in the United States, 
or even England. 

I might mention a number of hospices^ with important, bat not 
always interesting medical services, bat the above most for the 
present suffice. « 

Enough has been said to show the immense hospital accommo- 
dation Paris posseses. There are over 24,000 beds in the differ- 
ent hospitalS'-^not hospices — besides, there is a consultation 
gratuite (dispensary) attached to every hospital, where not less 
than 300 patients at each are daily prescribed for, and medicines 
given gratuitously. Add then the very numerous maisons de 
sant6, the large number of private clinics, and I am within 
bounds when I say that 60,000 persons are daily seen and treat* 
ed gratuitously by the profession. What class of people can claim 
such charity ! Do the merchants with all their boasted liberality 
do the same? Do the lawyers? or do even the clergy? It 
belongs to our noble profession to be the persouators of charity, 
and next to them to that disinterested, self-sacrificing corps of 
women, of the various religious orders of the Oatholic church. 
To have them as co-laborers is to have half the work done, and 
well done. May we always have them as our allies. 

Now compare the amount of hospital accommodation of Paris 
with any city in the United States, say St. Louis. Paris with a 
population of 1,800,000 or 2,000,000, with 24,000 beds, and as 
many again floating patients, gratuitously tended.^ St. Louis 
with -fff or ^f of population, has not all in all -f^ beds, and not -ff 
ambulating patients provided for. Comment is unnecessary. 

There is no greater mistake made, then, when young unexpe- 
rienced American physicians, without a knowledge of French^ 
come here to study medicine. It is time, labor, and money lost. 
Lectures are wholly incomprehensible to them, and cliniques not 
more so; for they invariably attend the central ones, (Charity, 
Clinique, Hdtel Dieu,) which are so crowded that not one bed in 
ten can be approached. And if approached, what is to be learn- 
ed in this galloping way of doing business ? If they would at- 
tend to the hospitals in the periphery of Paris, they might profit 
some, but I aver that no good can possibly arise from their at- 
tending the central hospitals. I see it daily, for it keeps me 
busy to explain the most apparent things. 



Foreign Correspondence. 817 

But for die experienced praotitioner, who at a glance will see 
what is going on, and to him who understands and speaks the 
langnage, Paris has no equal. Not at the leotures to students or at 
the sick bed of the great hospitals, but at those numerous private 
diniques and courses of lectures on almost every imaginable subject. 
The trulj great men of Paris must be sought after; they are hardly 
ever before the public. As a School of Medicine, Paris is greatly 
mferior to Vienna, Berlin, London, Edinburgh. They are not 
as rigid nor as censorious in examination, and are wholly im* 
praeiicable /or us •Anericaris in their ireaimeHl. Many im- 
portant branches are not taught at all ; thus, the diseases of the 
eye have no chair. One must go to private diniques to learn 
something. But for Desmarree, Sichely Deval^ Fano^ Paris 
would not be able to see ! ! In Vienna, the two brilliant and rival 
men, ^rll and Jdger^ attract crowds from all parts of the world. 
In Berlin are JUnken and the immortal Grmfe. All nations 
flock there. But Paris has no chair ; why ? because the old fogies 
of the faculty, Velpeau, Dubois, Bouillaud, do not like 8pedali«> 
ties, and yet they are spedalists themselves. 

The Obstetrical chair is filled by Dubois ; but this old fogy 
declines to give a course of lectures this year ; he only attends 
the diniques — doubtless the meanest that can be imagined. Such 
midwifery is killings literally ; for the mortality there is unparal- 
leled. 

To attend private courses is very laborious, very expensive. 
Still, it is the only means to profit from in Paris. Those who 
have neither time nor money to spare, or those not accustomed to 
very hard work, had better stay away. Let no one come here 
who does not somewhat understand and speak French. Many I 
know who spend all their time in learning French first ; in the 
meanwhile their means give out, their patience is exhausted, and 
they have to go. Why not rather go to London, Edmburgh, or 
Dublin ? In fine, Paris is an unrivalled place for men of expe- 
rience, with full knowledge of the language, not stinted in means, 
and of untiring industry ; any one who has not the command of 
these, had better try another place. 

Already has this communication passed a reasonable length. 
I will stop short, though much 1 have yet to say must be left to 
some other occasion. 



S18 Foreign (hrretpandeuee. 

I htre Tisited in Europe thus far fiftj-two intitatioiis for the 
Insane, familiarised mjselF with their organisation, maoagenenl 
and plan of treatment. I got the printed reports of moat of them, 
of which I will make a eopioos use, in some snbseqaent commoni- 
cation. In France and England, printed docaments relatire to 
public institutions are easily obtained, bnt in Italy not at all, and 
in Germany only with great difficalty and greater cost. In Italy 
they never make reports ; in Germany they make them, bnt do not 
often prini them. They are handed to the proper authorities, who 
put them among the archiTes, where they remain undisturbed. 
If a report is erer printed, it is put in bookstores for sale, to be 
obtained only for more than its worth. 

In England and France reports must be made, and are all print* 
ed, to be given gratuitously to any one who interests* himself in 
the subject they treat about. Very numerous invaluable docu* 
ments have I obtained from the various Ministers by merely ask- 
ing for them in writing. I was not bashful in asking. Bnt in 
Berlin they do not print; I could get nothing at all from the gov- 
ernment; and in Vienna, they print some and sell; all I obtained 
had to be dearly paid for. 

What a contrast between different countries, all alike making 
pretensions to enlightenment and liberality ! In Belgium, the 
government is as liberal as in either France and England, but 
employees like to earn a penny from unsophisticated tourists, 
which unfortunately for them I was not, and demanded peremp- 
torily what they pretended to give only for particalar considera- 
tions. 

Nothing can exceed the courtesy with which an earnestly en- 
quiring tourist is everywhere received in Paris. Every facility 
is given him to attain his object. From the Miuister down to the 
humblest employee, it is all the same. How much my countrymen 
might profit here, if they only would evince an earnest willing- 
ness to learn. 

I may not be able to write from Paris again, but will do so 
from England, and reserve myself abundant material for many 
commuDications when I am quietly seated at home, in my own 
St. Louis. 

Addendum. — I wish to add my appreciation of and thanks to 
the following three persons : 



Foreign Correspondence. 819 

,1. Claude Bernard^ whose bi-weekly lectures and practical 
demonstrations in Phjsiology at the College de France I have 
regularly attended, and found myself among an auditory, the 
like of which cannot be seen elsewhere ; not so much on account 
of numbers, as for character and standing. Celebrities and high au- 
thorities, not only from Paris but from all parts of the world attend 
these lectures. As a lecturer Bernard is very indifferent, but as 
a demonstrator he is unrivalled. He no sooner enunciates a physi- 
ological fact than he proves it. The crucible, the test-tube, the 
galvanic battery, are constantly being tried on numerous dogs, 
cats, rabbits, horses, sheep, frogs, etc. First he speaks, then he 
draws, then he experiments with equal rapidity and success. 
Orey-headed, richly decorated savans fill the hall, and bow respect- 
ful jissent to his new and to the world unknown facts. I have 
had the honor of being frequently in his company. He is a child 
in manners, but a giant in intellect. 

2. Charles Robin — Lectures and microscopical demonstra* 
tions in Anatomy and Pathology. An honest and faithful work* 
er, and a rigid enquirer after /ri/M, he admits nothing which can- 
not be chemically and microscopically proved. Hence, all he 
says is implicitly relied on. He does not compile, but he ex- 
amines, tests and proves. He is justly regarded as the most re- 
liable anatomico-pathological authority extant. 

8. E. Fotlinj whose weekly lectures and demonstrations on 
Optics, with microscopical and ophthalmoscopical apparatus, are 
too attractive not to be followed by all enquirers into the revela- 
tions made by these instruments. Fluent in delivery, rapid and 
accurate in drawing, successful in manipulation ; he is amiable, 
courteous, and in possession of abundant material. 

I wished to add the names of these three men to the above (my 
third) commanication, so that no American may neglect seeing 
them. Though my countrymen may not always understand 
what they say, they can at least see what they do, and profit 
by it. 



8S0 Si. Louis MecUcal Society Reports. 



ARTICLE III. 

Proceedings of the St. Louis Medical Society. By Thomas 
Kbnnard, M.D., Reporting Secretary. Physiological and 
Therapeutical Effects of Belladonna. {Continued from 
May number^ p. 129.) 

Dr. F. W. Whitb said, he was glad the subject of Belladonna, 
its physiological and therapeutical effects, had been brought before 
the Society. He was much interested in the subject, and anxious 
to hear from the members their opinions as to the maximum dose 
that could be safely administered, and what was meant by giving 
it to intoxication. Taylor, in his work on poisons, relates a case 
of death from this drug where only two or three grains had been 
taken ; but now we hear of it being given ^< to intoxication." A 
few days ago, I saw an article wherein the author criticised some 
remarks of mine, suggesting the use of iodide of potassium in- 
stead of chlorate of potassae, in this disease. The author recom- 
mended as a specific belladonna in intoxicating doses. 

Hahnemann suggested the use of this drug, as a prophylactic 
in scarlatina, as long ago as 1799, and his followers have ad- 
duced much evidence, of a negative kind, to prove this doctrine. 
I do not believe that it possesses any virtue, either as a prophy- 
lactic or curative agent, in the treatment of scarlatinal, croupal, 
and diphtheritic sore throat — a treatment so prevalent and fash* 
ionable among homoeopaths, who recommend and give it in enor- 
mous doses. It demands our attention the more, since not a few 
regular physicians entertain the same view, that it is prophylac- 
tic to scarlatina and kindred diseases. If this drug had been re- 
commended to us by an educated physician instead of a quack, 
its virtue would have been tested and its value determined long 
ago ; but with few exceptions regular medical men have not 
thoroughly tried it. Its introdi\ction as a preventive has been also 
attributedxto Castill^z, but there can be but little doubt that the 
honor, if there be any, is due to Hahnemann, who in 1799, in a com- 
munication published in Hufeland's Jounial, says, ^' I gave a girl 
ten years of age 77^^77 ^^ ^ grain of the extract of belladonna, 
(which he considered according to subsequent experience rather 
too large a dose) ; it had the desired effect. I have long been 



Si. Louis Medical Society Reports. 821 

in the habit of using belladonna as a sedative in coughs, and as 
a local application, with decided benefit ; and a year ago, when 
the sabject of diphtheria was discassed by this Society, I was 
anxious to have several points settled in reference to the differen- 
tial diagnosis of scarlatina, cronp, and diphtheria, upon which I 
then made some remarks. I am still desirous that the subject 
should be considered. The majority of cases of diphtheria that 
have come under my observation during the past twelve months, 
have been mild and recovered under very mild treatment ; but in 
some instances it was difBcuIt in the onset to distinguish them 
from croup and scarlatina, whilst others in the same neighbor- 
hood, and at the same time no more malignant, died when treated 
by belladonna and mercury in the hands of homoeopaths. 

In the remarks which I purpose making, I will attempt to prove, 
first, that facts do not sustain the theory of Hahnemann and his 
followers ; second, that the action of belladonna in the system 
does not sustain the assumption. I will read a few extracts, pro 
and con^ as I find them published in the British and Foreign 
Medico-Chirurgical Review for 1855, by J. Warburton Begbie, in 
his excellent review on the prophylactic power of belladonna in 
scarlet fever, which will suflBce for the first proposition. He pre- 
sents the following facts in favor of it as a preventive. Dr. 
Schenck witnessed its effects during an epidemic at Hilchenback 
in 1812. Eight persons had already died and twenty-two were 
then affected. Of 525 persons who used the belladonna, 522 
were not attacked by the disease, and the three persons who suffered 
were a mother and two children, who it is said were peculiarly 
exposed to the contagion, and had only taken the drug four times. 
Uufeland and Himley, his associate editor, of Hufeland's Jonrnai, 
both speak favorably of it as a prophylactic in 1812, and in 1825 
Hufeland himself writes as follows : ^' It is to me a great pleas- 
ure to be able to confirm, by new observations, the prophylactic 
power of belladonna in scarlet fever. It is now thirteen years 
since, in this journal, the first mention was made of the employ- 
ment of this preventive and each year since that time has brought 
with it a large number of corroborative facts." M. Masius, Pro- 
fessor of Medicine at Rostock in 1818, asserts his belief in it, 
founded on his own immunity from the disease during two years 
while treating cases of a malignant type. He took half a grain 
Vol. XIX — 21 



882 Si. Louis Medical Society Reports. 

of the extract every daj in four doses when Tisiting scarlet fever 
patientSi etc. M. Bemdt observed an epidemic in 1817, '18 k 
'19 in Gastrin. The following are the results of his observations : 
^^Of 195 children daily exposed to the contagion, and to whom I 
administered the belladonna, there were only 14 who, notwith- 
standing the remedy, contracted the disease, whilst the other 181 
were preserved. The fourteen who did suffer, had the disease less 
severely than those who had been similarly subjected to the infla- 
ence of the contagion without the belladonna." Muhrbeck speaks 
in the highest terms of its efficacy, having employed it about seven 
years and always with success. Behr, at Bernbourg, says, during 
an epidemic in 1820, and which though not at first of a formidable 
character speedily acquired a fatal aspect — among 47 Individ* 
uals to whom the belladonna was given, only six were attacked by 
the disease. Dr. Beeke, among other experiments in favor of 
the virtue of belladonna, mentions an epidemic in which 120 were 
already affected ; the specific was administered and thereafter only 
39 cases occurred. In Glasgow, among 94, seventy-six were 
preserved. Fifteen who had not taken the remedy were attacked, 
and three who had taken it were attacked, two of whom died. 

Here is a proud array of facts in favor of the prophylactic use 
of this drug, or its alkaline principle, atropia^ in number greatly 
exceeding those against its merits, and these are only a small 
portion of the whole number published in this paper ; but you will 
not fail to observe they are all negative facts, and rest on the 
presumption that all who took the remedy were by its virtue pro- 
tected. The argument runs thus : Many persons took belladonna 
during an epidemic of scarlatina, and were not seized by the 
fever ; therefore it is a prophylactic. We might more justly in- 
vert the argument, and say, certain persons took belladonna during 
the epidemic and were attacked ; therefore it is not a prophylactic. 

I Tvill now present a few opposed to this position. Dr. Lehmann 
says : ^' In a family consisting of three boys, the eldest was at- 
tacked — the other two were immediately removed from the sick 
room and were given the belladonna solution." <*Four days 
later the youngest was seized with the disease in a severe form ; 
he recovered ; and the third who remained in proximity to the 
patient, but at the same time took the belladonna regularly, con- 
tracted the disease and fell a victim to it." <^In a family of 



St. Louis Medical Society Reports. 323 

five brothers and sisters^ a boy of five years was first attacked 
with scarlet fever To the other foar the belladonna was imme- 
diately given. After eight days a little girl of four years was at- 
tacked and died. The following day a sister three years old took 
the fever mildly and recovered ; another sister of eleven years was 
almost immediately after seized and died. The eldest brother 
remained free from the disease." **A boy of seven years, an 
only son, contracted scarlet fever after having uninterruptedly 
during several months taken belladonna. The fever assumed a 
cerd^al character and he died on the fourth day.'' ^< In a family 
of four children, the eldest became affected with scarlet fever. 
The remaining three were immediately put on belladonna ; two of 
these on the twenty- first day of the use of the drug became affect- 
ed with the disease, in a severer form than the first child who had 
taken no belladonna." 

'< At Stralsund, Dr. Mierendorf observed, that the children to 
whom belladonna was given became more seriously affected, and 
died in much greater proportion than those to whom the drag was 
not prescribed. Dr. Schmidt lost two children, who had taken the 
same prophylactic. Of one hundred children so treated, fifteen 
became affected with scarlet fever and one died." 

Mr. Benj. Bell experimented in an epidemic at ^^ George Wat- 
son's Hospital" in 1851, and writes as follows : ^* Conceiving that 
no means for arresting the disease ought to be neglected, and that 
a favorable opportunity offered itself for testing the alleged pro- 
phylactic virtue of belladonna, I determined to give it a full and 
fair trial." ** Accordingly, on the 21st of February, upon the 
appearance of a second case of scarlet fever, the fifth part of a 
grain of the extract was given morning and evening to each of the 
boys. The dose was found in a few days to be too large from 
the dilated state of the pupil and impaired vision, which it occa- 
sioned in several instances. It was accordingly diminished, and 
then administered without intermission to all the boys, who con- 
tinued well until the 7th day of June, a full month after the case 
of scarlet fever had occurred. It is important to remark that 
the second case already referred to had been in the sick room, 
separated from the rest of the boys, for more than a week before 
the symptoms of scarlet fever had appeared, and that no addi- 
tional case occurred until the 21st of March, an entire month 



824 Si. Louis Medical Society Reports. 

after the belladonna had been regularly administered. There 
was thus ample time for the manifestation of its virtue as a pro- 
phylactic, but the subsequent occurrence of so many cases seems 
to throw considerable doubt over the existence of any such power. 
No experience of a negative character can be regarded as of much 
weight when contrasted with this positive experience now detail- 
ed. It is by no means unusual to meet with only two or three 
cases of scarlet fever in a large assemblage of children without the 
belladonna having been given at all, and we are therefore not 
called upon to give it the credit of securing a similar exemption in 
cases where it has been administered ; but merely the occurrence 
of twenty-three cases out of fifty- four boys who might be legiti- 
mately liable to the disease is an overwhelming evidence on the 
opposite side." 

Dr. Elb, a homoeopathic practitioner at Dresden, says: ^^I 
must add, that in general I did not find the prophylactic power 
of belladonna by any means so generally borne out ; although 
cases have come before me in which I gave belladonna as a pre* 
ventive, and the children to whom I gave it remained free from 
the scarlet fever. But just as often have I found that children 
have been attacked by it, notwithstanding the use of belladonna 
for several weeks, and that this long previous use of belladonna 
had not even the power of diminishing the violence of the dis- 
ease." 

Dr. West, in his excellent work, says : *^ Dr. Balfour experi- 
mented in the wards of the Royal Military Asylum at Chelsea, 
and says : ^ There were one hundred and fifty-one boys, of whom 
I had tolerably satisfactory evidence that they had not had scar- 
let fever. I divided them into two sections, taking them alter- 
nately from the list, to prevent the imputation of selection. To 
the first section (76), I gave belladonna; to the second section 
(76), I gave no belladonna. The result was that two in each 
section were attacked by the disease. The numbers are too 
small to justify deductions as to the prophylactic powers of bella- 
donna ; but the observation is good because it shows how apt we 
are to be misled by imperfect observations. Had I given the 
remedy to all the boys, I should probably have attributed it to the 
secession of the epidemic." 

Dr. Andrew Wood's experience in Heriot's Hospital, is thus 



St. Louis Medical Society Reports. 825 

mentioned by Dr. Simpson; "InHeriot's Hospital, Dr. Andrew 
Wood placed half the boys in each ward or sleeping division on 
belladonna, and left the other half without any such protection. 
The disease did not spread much ; but at least as many of those 
using the belladonna as those not using it were attacked ; and the 
only fatal case of forty which occurred, during that epidemic, 
was that of a boy who^ had been using belladonna in doses of 
one-eighth of a grain twice a day, for three weeks previously to 
his being attacked." It will also be observed, that most of the 
facts in favor of belladonna as a preventive were obtained after 
the epidemic had spent itself, which is not the case with those 
against its virtue as such ; and that many diedj notwithstanding 
this remedy had been faithfully given antecedent to the attack. 

The evidence in favor undoubtedly far exceeds in quantity but 
not in quality that against its preventive qualities. The argument 
is altogether negative ; how can it be known, therefore, that any 
one would have been seized with the disease in any of these epi- 
demics if belladonna had not been given? Quality of evidence 
is admitted to be superior to quantity in a civil court, and it 
should be so, especially before the bar of a scientific profession. 
One positive relevant truth is more valuable as evidence than one 
thousand negative witnesses. In rheumatism, for example, many 
contend that lactic acid exists in every case ; but if one case has 
been known to exist with alkaline urine, it certainly proves that 
lactic acid is not a necessary accompaniment of the disease. Dr. 
Benjamin Bell's facts and those related by the homoeopathy Dr. 
Elb, weigh more with my judgment than all the others read. 
But when Dr. Bell tried his experiments, it was a principle of 
homoeopaths to deal with infinitesimals ; they argued, therefore, 
that he used the preventive in too large a dose, and hence failed 
in his experiments. But any rational man must acknowledge 
that to act on the doctrine of similia similibusj it must produce 
the sore-throat and exudation peculiar to that disease, and if it 
has this power it can only so act with benefit in a poisonous quan- 
tity, certainly not in infinitesimal doses inappreciable even with 
the aid of the microscope. Hahnemann and his followers in 
using it contended that it acted upon the principle, ^^ similia . 
similibus curanter;*^ but we neither find it producing the scar- 
latinal sore throat, nor any other condition peculiar to that dis- 



826 St. Louis Medical Soeidy Reports. 

ease. Here we meet the argument of the modern homoeopaths, 
who ignore Hahnemann's infinitesimal doses, but still contend that 
it acts upon the principle '^ similia similibus." We deny that this 
agent produces conditions identical with those accompanying 
either scarlet fever, croup or diphtheria, since none of the symp- 
toms which it produces are at all similar. Before it can have 
any effect upon the throat, it must bo given in poisonous doses, 
when it will cause only k peculiar dryness and constriction of the 
fauces. The angina in these diseases is an effusion, an exuda- 
tion, and the eruption begins with little red spots, which soon 
become very numerous and run together and afterwards desqua- 
mate, whilst belladonna produces only a diffused livid appear- 
ance of the skin without desquamation. 

Let us pass to the question, — what are its physiological and 
pathological actions ? It will not be difficult to prove that the 
admitted action of belladonna upon the system does not suggest 
its use in these diseases either as a prophylactic or curative agent. 
Bailey asserts, ^^ that it affects neither the stomach nor bowels, 
neither excretion nor secretion, except of the salivary glands." Its 
general action being that of a powerful and most dangerous nar- 
cotic, Headland classes it among deliriant narcotics. Being an 
active sedative, its physiological effect is often extreme. This 
should point us to its most remarkable therapeutic power when 
administered in appropriate cases. Its physiological action is 
first by slight stimulation, and afterwards by great depression of 
the vital activities. It differs therefore from some other narco- 
tics, which possess great stimulating power, as, for instance, 
alcohol, chloroform and ether, which possess only moderately 
sedative powers. Now can such a depressor be indicated in 
malignant scarlatina and diphtheria, where the tendency is to 
depression almost from the beginning, characterized by exudation 
growing out of a dissolution of the blood ? 

Exudations are respectively euplastic, caco-plastic, or aplas- 
tic. In the case of croup, the formation may be plastic, highly 
fibrinous; in scarlatina, almost entirely aplastic, sero- albuminous, 
and tending to putrefaction. Diphtheria appears to rank between 
the two, the effusion being either fibrinous when the attack is acute 
and sthenic, or fibro-albuminoid, or indeed, if slow, insidious and 
asthenic in its approach — the effusion may be sero- albuminoid. 



Si. Louis Mediae^ Society Reports. 827 

Now, we cannot understand how belladonna can exert any bene- 
ficial effect in such diphtheria where all antiphlogistics or seda- 
tives are injurious. We need stimulants from the beginning. If 
it be true that malignant diphtheria, scarlatina, and croup, are 
blood diseases, a narcotic is certainly not indicated — alteratives 
are needed. I think iodide of potassium has probably the highest 
claim. It has always been used with benefit in the sloughing mer- 
curial sore throat — a condition almost identical with that of 
diphtheritic ulceration ; mercury would be for this reason a bad 
remedy, especially after the acute stage had passed. Iron and 
alkalies are the great constitutional means. Diphtheria is a true 
blood disease, and I would use stimulants to elevate the nervous 
power, whilst I would use alteratives and tonics to cure the blood 
disease. It would appe&r therefore irrational empyricism to ad- 
minister belladonna ^^to intoxication?^ in these diseases. 

Dr. M. A. Fallen. In regard to the therapeutical effects of 
belladonna, in the main, I fully concur with Dr. White, and as 
far as the contra -indication to its use, I think he has completely ex- 
hausted the subject ; but other points might be more fully elabo- 
rated. I am sorry I did not hear, at the last meeting, the precise 
question for discussion this evening, or I might have collected 
some facts which would wholly disprove its prophylactic effects. 
I have tried it several times, and in every instance it has failed. 
In one house where it was freely given, seven patients had malig- 
nant scarlatina, and in various other instances a similar result has 
followed. As mentioned in one of the extracts read by Dr. White, 
many hundred children took the belladonna and only six of them 
had the scarlet rash, thus proving that it does not act upon the 
principle "similia similibus curanter,'* even if there be any 
analogy between the sore throat produced by belladonna and that 
common to scarlatina, diphtheria, croup, ormuguet. In the first 
place, I deny that there is any correlation of these diseases. In 
thrush, the formation in the buccal cavity depends upon the 
oidum albicans J and is of parisitic origin. There is a correla- 
tion of symptoms between this and the other diseases just men- 
tioned, but not of causes. In croup the exudation is decidedly 
plastic, whilst in diphtheria it is aplastic, and I have thought it 
was due to a true necrosis of the blood. Group is generally de- 
cidedly sthenic, high fever, strong pulse; whilst in diphtheria 



SL Louis Medical Society Reports. 

there is marked prostration, pulse rapid, but frequent and weak, 
and the exudation of croup begins lower down in the larynx than 
that of diphtheria. I am sorry I did not hear Dr. Kennard's 
essay, and may repeat what he has said : I beliere the diphtheria 
we meet with differs considerably from that described by Breton- 
neau. We find the exudation will form on any exposed mucous 
membrane, the throat, the nares, the vagina, etc., and on denu- 
ded surfaces, but it never however extends down the aosophagus or 
is found on any mucous membrane not exposed to the air, which 
is an indication that it depends very much upon atmospheric in- 
fluence, is due to some poison in the atmosphere which is absorb- 
ed, taken up by the epithelial cells on the mucous membrane. 
There is certainly a zymosis of the blood in this disease and cer- 
tainly belladonna can exert no beneficial alterative influence on 
that fluid, and hence its use is contra-indicated. The stimulant and 
tonic method of treatment with good nutritious food is best — such 
as milk, eggs, etc. I might perhaps modify my definition of 
croup somewhat, by saying, the blood is diseased secondarily. 
At first, true croup is most generally a true laryngo-trachetis, a 
pure inflammation, and the changes in the blood result from its 
carbonization for want of oxygen, diminished supply of air, and 
afterwards ursdmic poisoning follows from checking of secretions. 
Its treatment in the primary stages should be depletion, general 
and local, free use of tartar emetic ; but such treatment would be 
very wrong in diphtheria, for it would only hasten the destructive 
effects of the zymotic poisoning. I think scarlet fever, though of 
the same genus, does not belong to the same species of disease 
as either croup or diphtheria. They exist together and follow 
each other, and must be treated according to the precise condition 
of each individual patient. If sthenic we may deplete, and if 
asthenic we must stimulate and support ; but I do not see that 
belladonna could be indicated in any case. 

Dr. Kennabd said, he had noticed several cases reported in the 
journals tending to prove that opium and belladonna were true 
antidotes for each other, and that poisoning by one could be 
cured by the other. He would ask the experience of the members 
upon the subject. 

Dr. Wm. Johnston said that numerous cases had been re- 
ported in the London Lancet, proving that opium and belladonna 



St. Louis Medical Society Reports. 829 

were matiial antidotes. In ten cases reported by Dr. Seaton, in 
the Medical Times and Gazette, where poisoning From belladonna 
had happened, two cases treated by emetics recovered slowly ; 
of eight who were fnlly poisoned and suffering from delirinm 
and wakefnlness, seven took opiam and recovered as soon as its 
effects upon the system (as manifested by contraction upon the 
pupil and sleep) came on. The other case was in bad health, 
took bat little opium and died. 

Dr. Newman said, he had been surprised to read of belladonna 
being given in such enormous doses, as much as a scruple a day. 
In one of the cases referred to by Dr. Johnston, as much as fif- 
teen grains of morphine were given as an antidote before the sys* 
tem became affected, two grains every two hours. He had used it 
a long time, but very carefully, and considered it dangerous. It 
was an important and very useful remedy in nervous diseases, in 
coughs, and as an external application. I never exceed the one- 
fourth of a grain of the extract at a dose, and then the poisonous 
effect is sometimes produced. I use it frequently with stram- 
monium ointment for hemorrhoids. Last year I ordered 1 drachm 
of it with a half ounce of the strammonium ointment for a very 
painful and annoying boil, which relieved all the pain in six or 
eight hours, but produced violent symptoms of poisoning by the 
one external application, which however passed off and there was 
no further trouble. 

Dr. McGiNTiB had used it frequently and for a long time with 
benefit in dysmenorrhoea. He had also used it in whooping- 
cough ; but could not say much for its value. Had once taken 
himself five drops of fluid extract for neuralgia, which did no 
good but produced the poisonous effect. 

Dr. M. M. Pallbn remarked, that during the discussion of the 
properties of belladonna, very little had been said about its power 
of dilating the os uteri. We all know that it does dilate the pu- 
pil, and that it is very probable that it does so by acting on the 
longitudinal fibres of the iris, contracting them, and at the same 
time of necessity dilating the circular fibres. Now we find an 
analogous formation of circular and longitudinal muscular fibres 
entering into the formation of the mouth of the womb, and we 
might very naturally suppose belladonna would assist in dilating 



880 Si. Louis Medical Society Reports. 

• 

the 09 tinc» in a similar manner ; but I have never yet seen any 
positive proof that it did, although I have used it frequently for 
the purpose. It certainly does good in chronic inflammation of 
the conjunctiva, acting 1 believe as an astringent, and thus con- 
stricting the capillary blood-vessels, as it does those of the mouth, 
producing marked dryness of the throat when taken in an over- 
dose. I imagine it acts the same way on the mammae, by con- 
stringing the blood-vessels, checking secretion and preventing 
suppuration, when locally applied to the inflamed breast. Some- 
times in primapara, we find the neck of the womb high up and 
back towards the sacrum, with os but slightly dilated, and the 
anterior lip projecting. I bad a case of this kind a week ago. 
The plan I employ to remedy this, is to pass the finger into the 
mouth of the womb and gently pull it down anteriorly, thus mak- 
ing the head of the foetus bear more directly upon the os uteri, 
which generally hastens labor. I have used this method success- 
fully for some time, and recently saw it recommended in the Lon- 
don Lancet. 

FBACTURB OF THB STERNUM. 

Dr. McPhbbters reported a case of fracture of the sternum, 
the upper third. There was but little trouble in detecting the na- 
ture of the injury, there being marked prominence in front. 
Fractures of this bone are very rare, and always caused by vio- 
lent falls or blows. I simply applied a firm compress and made, 
gradual pressure, and up to this time no bad symptoms have 
occurred. 

Dr. Eennard said, that Dr. Van Studdiford told him he had 
recently had a very remarkable case, in which after delivering a 
lady of a healthy child, there were two separate placentas dis- 
charged, the one belonging to the child, and the second developed 
to about two-thirds the natural size, and having a hard calcareous 
formation as large as a goose egg attached. The peculiarity was 
the development of the placenta, when the ovum must have been 
blighted at a very early stage of pregnancy. 

Dr. Greoort mentioned a peculiar case which occurred in the 
hospital, a few days since. A patient presented himself with a 
swelling in the right iliac region the size of a cocoanut. It be- 
gan about two weeks previous, apparently without any cause ; had 



St. Louis Medicai Sodeiy Reports. 881 

gradaallj increased in size, bat was not verj painful. The history 
of the case proved it to be inflammatory in nature, and in feeling 
and appearance it resembled a common abscess ; but it was reso- 
nant, evidently containing air, so that I hesitated to open it. Sev- 
eral other physicians saw it, and all thought it must be an abscess, 
but could not account for the resonance. After having it examin- 
ed by several of our most eminent physicians, all of whom, like 
myself, believing it an abscess, but not able to account for the 
resonance, I opened it, and air, pus and fecal matter were dis- 
charged. A post-mortem showed several openings in the intes- 
tine, and, also, that I did not make them. The openings were 
primary, and the abscess, a consequence, followed them. It was 
very strange that the patient, who was intelligent and seemingly 
reliable, said he had iiad no derangement of bowels and had had 
no pain in the tumor. 

Dr. HoDGSN said, he was informed to day that the Cesarean 
section had been performed during the past week upon a woman, 
who died at the City Hospital during labor, and a living child 
removed, which was doing well. The operation was performed 
by two young men, assistant physicians in that institution. 

Dr. HoDGBK. This evening I wish to call the attention of the 
Society to another invention of my own, in which I trust you will 
find, not only something useful, but something new. It is a 
splint, intended for the treatment of compound fractures of the 
lower extremities with the external injury on the posterior aspect. 
The splint is so arranged that the external wound can be reached 
and dressings Applied without the least disturbance to the limb* 
It consists of a double inclined plane with the usual joints at the 
hip and knee ; the thigh piece is divided in its length ; the hinges 
are made of strong linen tapes, beginning above and below on the 
base, passing to its posterior; those above are continued on the 
thigh pieces above, and those below are continued on the thigh 
pieces below; they occupy these positions forward to the joint at 
the knee, where they change their positions ; those above on the 
thigh piece are carried below on the part on which the leg rests, 
and those below at the thigh, pass on the under surface at the leg. 
By ratchet wheels on the under surface of the leg piece, the tapes 
(that are above at this point) after passing through a mortice 
can be tightened or loosened. 



382 Si, Louts Medical Society Reports. 

When it is necessary to dress a wound on the back part of a 
fractured thigh, the tape connected with one of the ratchet wheels 
is loosened, and one half of the thigh piece is let down, the thigh 
being supported by the remaining part, which also keeps the leg 
piece in its place firmly, so that extension is fully maintained. 
When dressings have been applied to this part, the ratchet wheel 
is turned, the tape shortened, and the thigh piece brought fully 
and firmly into place. The other part may then be managed in 
the same way. 

The same arrangement may be made with the leg piece, by 
dividing it and reversing the position of the fixed and free ends of 
the tapes. 

With this instrument, I (in connection with Prof. Moore) treat- 
ed a case of compound fracture of the thigh — the bone being 
broken at two points (only one fracture communicating exter- 
nally,) during the last summer, in a boy five years old, with per- 
fect success, and comparatively little trouble. 

Forty-two days after the accident, the splint was removed, and 
the limb was not, so far as I could ascertain, shortened in the slight- 
est degree. 

Dr. Hermann Stieren read the following report of a case 
treated by him : 

METRITIS PABENCHTMATOSA. 

Sometime ago, I was called to see a woman who had been 
given np as dying by the physician who had treated her up to that 
time, but thought it unnecessary to visit her any longer. When 
in the evening I came near her residence, I heard her scream a 
distance of about fifty yards, and on entering the room found her 
in the greatest agony. 

Several weeks previously to her present condition, she had had 
(as her husband told me) inflammation of the bowels, which be- 
ing over, she had in consequence of menstruation an uncommonly 
great loss of blood, which kept on for four or five days, although 
she had always before menstruated very regularly. The then at- 
tending physician had administered to her the aromatic sulphuric 
acid, one dose of which stopped the menstruation entirely. But 
the next day she complained of pain in the belly, and had great 
difficulty in urinating ; and when I saw her for the first time. 



SL Louis Medical Society Reports. 888 

about fonr days after she had taken the medicine, she suffered 
greatly with pain in the back and in the side ; had had no opera- 
tion of the bowels for several days, and could not urinate. 

Upon examining the belly, I found it the size of that of a wo- 
man in the fifth or sixth month of pregnancy, and she could 
scarcely suffer it to be touched. The introduction of the finger 
found the uterus much enlarged and prolapsed; the specu- 
lum showed the uterus enlarged, greater turgescence than natural, 
more sensibility, and of a dark-violet color, particularly around 
the orifioium, which secreted very abundantly a turbid, yellowish, 
pus- like substance. The examination per anum, which caused 
the patient great pain, showed an inflammation and contrac* 
tion of the rectum, from which poured out a turbid, whitish liquid. 
I ordered five grains of calomel with half a grain of podophyllin, 
to be taken directly, and a tea consisting of juniper berries, uva 
ursi, water-fennel and parsley-seed, to be taken freely during 
the night, and frequent injections of ice-water into the vagina as 
well as into the rectum. 

Barly the next morning I found the woman very little relieved, 
although she had been able to urinate and had also had a passage. 
I then ordered cupping on the swollen parts of the abdomen, af- 
ter which anointing these parts with mercurial ointment, mixed with 
extract belladonna, which was rubbed in every two hours. Besides, 
I prescribed a solution of three drachms nitrate of soda and one 
grain of morphia in five ounces of water. One tablespoonful to 
be taken every three hours. In the afternoon I applied around 
the orificium uteri three leeches, which took off a large quantity 
of a dark-red, almost black blood. The next day I found my 
patient much better, complaining of only little pain ; when, five 
days after the first time I applied three other leeches, and after 
another week three more. The patient having taken all the time 
a solution of one drachm of ferro-citrate of quinine in five ounces 
of water, and having used frequent injections of cold water into 
the vagina and rectum. 

About a week after beginning my treatment I saw the patient 
enturely out of danger ; and after two weeks more she had so far 
improved, that she was able to visit me in my office, which was 
about twelve squares distant from her residence. 



884 JV^raie of Potash in Intermittent Fever. 

ARTICLE IV. 

JYitrcUe of Potash in the cure of Intermittent Fever. By 
Amos Sawybr, M.D., of Hilhhoro\ Illinois. 

^ — Potassae nitrat., gr. x.; Spr. yini gallici-vel. aquas, 1 88. 
S. — ^M. — ^Take immediately. 

The above prescription I have used with great success in the 
cure of intermittent feyer, even where quinine has failed. In my 
opinion no preparation is equal to it ; for it possesses antiperiodic 
properties completely, and may be administered, when the stom- 
ach would not tolerate quinine. I deem it a specific in ague ; 
for I have never failed to arrest the paroxysm, if uncomplicated. 
You will also find that the patients are less liable to relapse than 
in those cases cured by quinine. In the cold stage, if adminis- 
tered in a full dose, and the patient be placed in bed and covered 
with blankets, he will in a few minutes experience considerable 
heat, which will be followed by copious perspiration, and every 
unpleasant feeling will vanish. It is seldom the patient will ex- 
perience a second attack. Where it is more agreeable to the 
patient, the powder may be placed on the tongue and permitted 
slowly to dissolve. 

I shall not attempt to explain the action of this medicine 
on the system in the cure of ague, but will leave that to 
older heads than mine to determine ; still, we do know that 
after it is taken into the stomach and becomes absorbed, it has 
the chemical effect of changing the dark -colored venous blood, 
to arterial, or at least it changes its color. It also acts on the 
kidneys as a stimulant producing diuresis, as well as diaphoresis ; 
and in this manner may rid the system of the poison that causes 
the ague ; provided that poison is produced ^^ by the retention of 
materials destined for excretion." This medicine more closely 
resembles nature's mode of curing this same dbease than any 
other ; as she cures by copious diaphoresis as well as diuresis, or 
in other words by elimination. 



PART II. 

REVIEWS AND BIBLIOGR APHS. 

ARTICLE I. 

Hand' Book for the Military Surgeon : being a Compendium 
of the duties of the Medical Officer in the Field ; the Sani- 
tary management of the Camp — the Preparation of Food^ 
etc.; with Forms for the Requisitions for Supplies^ Re- 
turns J etc. : the Diagnosis and Treatment of Camp Dysen- 
teryy and all the important points in War Surgery y in- 
eluding Gun -shot fFounds, imputations ^ Wounds of the 
Chesty Abdomen J %Srteries and Heady and the use of ChlO' 
roform. By Chas. S. Teiplbr, A.M., M.P., Surgeon U. S. 
Jl.y and Georgb C. Blackman, M.D, F.R.M.S., Professor 
of Surgery in the Medical College of Ohio ; Surgeon to the 
Commercial Hospital; St. John^s Hospital^ etc. Cincin- 
nati: Robert Clark * Co., Publishers y JVb. 66 West Four- 
teenth street. 1861. 

The object and aims of this little work are fully set forth in the 
very elaborate title page which we have copied above. A more 
opportune work could not well have been presented at this time. 
The civil war which now unhappily exists, has called into the 
field a large number of physicians to act as surgeons and assist- 
ant surgeons ; who, however well skilled in their profession, 
are wholly ignorant of the duties and requirements of camp 
life, which can only be acquired by experience. Under these cir- 
cumstances, to have for their guidance the directions of such an 
experienced army surgeon as Dr. Tripler is a very great advan- 
tage, and one which we doubt not, all who can, will avail them- 
selves of. Not the least useful part of the wotk is the appendix, 
in which are to be found supply tables, forms for requisition for 
supplies, returns, etc. 

The chapter on Wounds of the Abdomen, Head, and Arteries, 
are by Prof. Blackman, whose competency for the task no one will 
question. We advise all who are, or who expect to become Army 
Surgeons, to procure a copy of this work, which is of such size 
as to render it conveniently portable while on duty in camp. It 
may be had of the publishers, whose address is given above, at a 
cost of one dollar. 



886 Bibliographical Notices. 

ARTICLE II. 

•4 Treatise on Fever ; or Selections from a Course of Lee* 
tttres on Fever. Being a part of a Course of Theory and 
Practice of Medicine. Delivered by Robbrt D. Lyons, K. 
CO., M.B.T.C.D., Physician to Ferbis street Hospital; 
Formerly Clinical Assistant to the Meath Hospital; Pro- 
fessor of Practice of Medicine and Pathology in the Schod 
of Medicine in the Catholic University of Ireland; Late 
Pathologist'in- Chief to the British Jirmy in the Crimea^ 
irc.y 4*c. Philadelphia: Blanchard 4* ^^^* PP' 849. 
1861. 

The object of the author in the work before us on Fever, is 
^^ to bring within the reach of the student and junior practitioner, 
in a convenient form, the most recent results of enquiries into the 
Pathology and Therapeutics of this formidable class of diseases." 

There is no subject of more practical importance to the practi- 
tioner of this country than that of fever, and notwithstanding all 
that has been written on the subject, it has lost none of its inter- 
est. Ireland is well known to be subject to aggravated forms of 
the same types of fever that prevail in this country ; and Irish 
writers and practitioners stand preeminent for the ability with 
which they have written, and the skill they have manifested in the 
treatment of these formidable complaints. The writings of Stokes 
and Graves are familiar to all. The writer of the work before us 
has been edacated in the same school, and has enjoyed like ad- 
vantages with these great masters of our art, in acquiring a prac- 
tical knowledge of fever ; and his work is entitled to rank among 
the very best monographs on this important department of prac- 
tical medicine. 

The work contains eleven chapters, with a copious index, em- 
bracing the general and special pathology and classification of 
fevers : — Simple continued fevers ; Varieties of synochial fever ; 
Typhus and typhoid fevers ; Typhoid fever of Crimea ; Yellow 
fever; Pathological anatomy of yellow fever, &;c., &c. This 
will give the reader some idea of the scope of the work. On all 
these subjects, the views of the author are clear and perspicuous, 
and abound with suggestions on pathology and practice which are 
of marked interest to the practitioner, and we therefore commend 
the work to our readers. 



Classification of Tumors. 887 

( Ck>ntiiiiied from page 256. ) 

THB CLASSIVIOATION, DIAQNOSIS AND PROGNOSIS 09 TUMORS, FROM 
A CHIRURGIOO- CLINICAL POINT OF VIEW. BRIEFLY ARRANGED 
BT DR. THBOD. BILLROTH. {Deuische Klinzkj 1859.) 

TraUUted hj G BMmgartflii, M.D. 

The adenoids of the breast occur almost in every age from the 
12th to the 60th year, in married as well as single women, with 
or without children. Their diagnosis is occasionally very difficnlt, 
especially in the beginning ; as long as they are only swellings of 
the size of a bean or nnt, they cannot be distingnished from en- 
gorgements of single acini as they of ten occnr in women, (not 
considering even the period of lactation,) and in younger or older 
girls — movable painless nodes, of which one can at first give no 
definite opinion ; the progress, only, and the snocess of resorbent 
remedies will make it clear, whether we have to deal with a chronic 
inflammatory engorgement or with a tnmor. If the node grows, 
becomes uneven, lobulated, but remains painless, retains its firm 
elastic consistence and is movable in the gland itself and under 
the skin ; the diagnosis of adenoid tumor can be made with much 
probability, especially if its growth is very slow and the tumor 
occurs in a young person. In older persons such a tumor not 
unfrequently undergoes a gradual change: it becomes painful, 
grows more rapidly, becomes very hard in the periphery, soft on 
the apex and altogether more and more immovable, until finally 
we can no longer doubt that we have now to deal with a carci- 
noma, especially if the axillary glands also begin to swell. Such 
metamorphoses of adenoid tumors into carcinomata do occur and 
can be anatomically demonstrated. In general, the course of 
adenoid tumors is favorable, the more so, the younger the indi- 
vidual, and the more fibrous the tissue of the tumor is at the same 
time ; the nearer the interstitial tissue approaches to the colloid, 
soft or medullary sarcoma, the older the individual, so much the 
worse is the prognosis ; in the first place, local relapses will oc- 
cur, which then present themselves as pure carcinomata. Former- 
ly, I would not have believed it, that, in such cases an adenoid 
tumor really had been extirpated, had I not convinced myself of 
Vol. XIX— 22 



888 Classifieation qf Tumors. 

it by my own investigations ; the returned tumor is extirpated, 
but very soon returns again locally, then in internal organs and 
in bones — ^in many oases, passing by the axillary glands, in others, 
after these also had degenerated into carcinoma. These secondary 
tumors almost always have a medullary character. In regard to 
the causes of such carcinomatous degeneration of adenoid tumors, 
especially in aged women, nothing definite can be asserted ; I be- 
lieve from some cases I may conclude that grief, cares and pov- 
erty can conduce to it, as A. Cooper also teaches. The prognosis 
of adenoid tumors must therefore always be made with caution, 
even although in the purest forms the fatal issue is among the 
rarest, and, as has been remarked, is never to be feared in young 
persons, unless it be that the tumor had a true medullary charac- 
ter from the very beginning. 

Many sarcomata of the salivary glands may also sometimes 
present a gland* like appearance, but yet this comparison is very 
far-fetched ; we will speak of these tumors in connection with the 
soft sarcomata. 

2. TTie Colloid Tumor ^ Myxoma^ Collontma^ Colloid Can- 
cer j Jllveolar Cancer. — Tumors of the consistence and color of 
boiled glue pertain to the most various' tissues and are capable of 
very numerous combinations. Athough they do not, histologi- 
cally, belong together, (sometimes one is puzzled as to whether 
they are cartilage, connective tissue, or a secretion,) yet in a 
clinical regard they form one group, inasmuch as all have a great 
tendency to return locally, and some of them, also, not seldom 
spread over the entire organism. In the first place, two forms 
of these colloid tumors can be distinguished by the naked eye, 
which by the microscope may be further divided into several 
sub-species. 

(a) Homogeneous colloid sarcomata: they are rare in their 
pure form and always present on a cut surface a number of fine 
red dots, small extravasations, but otherwise no further structure. 
They occur jnore especially on fasciae, combined with fibroid 
masses, with soft or even medullary sarcomatous substance ; fur- 
ther, in the mammary gland, combined with adenoid and cystic 
formations ; also, in the salivary glands, and finally, in the upper 
maxilla, in combination wit^ fibroid tumor and fibro-sarcoma. 



daBftfieation qf Tumors. 889 

Local relapses are not nnfreqnent, with more or less dangerous 
character according to the nature of the combination. 

(6) Areolar colloid tumors: in these, we see with the naked 
eye a mnltitade of white capsules, in which the jelly is inclosed ; 
when this is very flaid, the tumor assumes the character of the 
cystoid tumor or cysto* sarcoma, as in those growths frequently 
occurring in the ovary and the thyroid body (as struma lympha- 
tiea with accidental tuberculisation, calcification, eztrayasation, 
etc.) 

Colloid enehondromata have almost the same appearance; 
they can sometimes be diagnosticated as such only by the aid of 
the microscope; in other cases, there is present besides the jelly 
a cartilaginous mass, distinctly recognizable with the naked eye. 
The soft cartilage in this case has by no means always resulted 
from one that had been firm, by softening, but has been prima- 
rily formed as such, the intercellular substance not having ac* 
quired the normal hardness. The favorite seat of these tumors 
is the scapula, the thigh, and the bones of the pelvis ; they often 
cause very obstinate local relapses and sometimes lead to a gen- 
eral development of enchondroma in internal organs. 

The colloid carcinomata have smaller, mostly microscopic 
alveoli, and occur principally in the liver and rectum ; they are 
extremely rare, but finally spread in great number, e. jp., as small 
tubercles over the entire peritoneum. They do not, as far as my 
experience goes, essentially differ from the colloid enehondro- 
mata, except that well formed cartilaginous masses do not occur 
about them. 

3. Cystoid Tumors and Cystosarcoma. — ^By cystoid tumor 
is understood a convolution of cysts, without other neoplastic 
mass than the walls of the cysts and their contents. In this purest 
form they occur seldom, and then contain either pure serum or 
mucus, that may be colored by blood from a light yellowish-red 
to a deep brown ; their occurrence is confined almost alone to the 
ovaries, the testicles, and the cervical and sacral regions ; in the 
latter case, usually congenital, as so-called cystic hygroma. 
Cystoid tumors do not return, if they can be extirpated com- 
pletely ; only consequent upon a pure cystoid in the testicle have 
I observed medullary tumors to form in the abdomen. 

Cystosarcomata are called those tumors which consist partly 



840 Cla$9ification ^ 7\imar$^. 

of firm tissne, partly of cysts. Nearly all species of cysts can 
occnr combined with nearly all species of tissues ; the nature of 
the latter determines the prognosis. The Inznriance of the tissue 
can advance even into the cysts themselves in form of dnbshaped, 
polypous vegetations, or papillary excrescences, especially in 
the mamma: Cystosarcoma phyltodesj proliferum MueUeri. 
Among the innumerable possibilities of combination, the follow- 
ing are the most frequent: In the mamma — adenoid tumor and 
colloid tumor combined with cysts ; in the testicle — cysts with 
cartilaginous formations and medullary cancer (occasionally with 
development of bone, pearly tumors, pigment, muscular fibres, 
etc.) ; in bones, especially the upper and lower jaw — ^firm yel- 
lowish-red sarcomatous substance combined with mucous cysts, or 
osseous cystoids with a little sarcomatous mass on the walls of 
the cysts, which contain mucus ; congenital in the sacral region : 
sarcoma with cartilage and extensive development of blood- 
vessels, etc. 

4. Firm Sarcomata. — The name sarcoma is a most unfortu- 
nate choice of the ancients ; it is intended to denote ^' fieeh- 
tumor," but what is to be understood by ^^flesh" is not clear; 
later afathors would have it signify muscular substance, but then 
the sarcoma would be eminently rare, and not oecnr at all in the 
pure form ; it could be diagnosticated only by the microscope. 
Histologically, we mean at present by sarcomatous tissue one 
which represents difi'erent degrees of development of connective 
tissue: granulation- like tissue, Yirchow's mucous tissue with more 
or less intercellular substance up to fibrous tissue, tissue consist- 
ing of spindle-shaped cells, without intercellular substance {iissu 
fibroplastiquej Lebert), or with colloid or fibrous intercellular 
mass. All these tissues carry the name of sarcoma so long as 
they grow at random without definite areolar arrangement, only 
pursuing certain directions of fibres, and sometimes even without 
these. According to the external appearance I would separate — 
the Jirnif the so/t^ and the medullar]/ sarcomata^ of which last 
will be spoken in connection with the medullary tumors. Gen- 
erally characteristic of sarcoma is a globular, tuberous form, ac- 
curate limitation against the neighboring tissues and almost ex- 
clusively central growth of the tumors with the direction towards 
the cutaneous surface, without transforming the adjacent organs 



<llasnJicaKon of Tumors. 341 

into morbid tissne, but only forcing them aside, — and tbe ten- 
dency to coalesce with the skin and ulcerate superficially. The 
consistence, the color, and the character of a cut surface is yery 
variable; the latter is usually homogeneous throughout, without 
allowing any structure whatever to be recognized with the naked eye. 

By firm sarcomata^ I mean such as have a firm, elastic con- 
sistence, dirty light yellowish- red section, that usually becomes 
darker by exposure to the air, and from which a little opaque 
serum can be expressed. 

These sarcomata occur, in the first place, in submtaneous cel- 
lular tissue and in the cutis^ are here remarkable for their ex- 
tremely slow growth, and have alardaceous, wax- colored section; 
they arise frequently from the fasciao on the abdominal walls, 
thigh, (especially in women,) shoulder, and back. The slower 
they have grown, and the more amorphous their structure, the 
less noxious are they ; their combination with distinct fibroid sub- 
stance or with medullary mass excites the suspicion of their 
capacity for local and general relapses. They are, like fibroid 
tumors, poorly supplied with capillaries, but likewise contain small 
arteries, from which, when corroded, enormously violent hemor- 
rhages can take place, as in the case of the fibroids. 

The eeniral osteosarcomcUa^ moreover, belong to this class 
{myeloid tumor ^ Paget). Their favorite seat is the lower jaw, 
especially in children ; here they occur purest and sometimes com- 
bine with development of mucous cysts and of osseous trabeculse 
in the sarcomatous mass ; the latter is situated in the centre of 
the medullary cavity of the bone ; the cortical layer seems puffed 
up like a bladder, and rises above the healthy bone pretty abruptly. 
These tumors of the lower jaw but seldom return if they were 
thoroughly extirpated. In other bones, e. ^., ulna, radius, tibia, 
though with greater development of new-formed substance, the 
relations of the latter to the bone remain the same, — ^yet the 
tumor itself sometimes changes so considerably by tuberculisation, 
extravasation of blood- formation of cysts, calcifying and ossify- 
ing, and extensive development of blood-vessels, that it is diffi- 
cult to recognize the original substance of the tumor. These lat- 
ter sarcomata occur almost exclusively in adults of middle age, 
and usually necessitate the amputation ; metastatic tumors conse- 
quent to them are rare. 



842 Clasnfieaiion of Tumon. 

TumorSy very similar to these central osteosaroomata, are also 
found on the gums, in old and young persons ; here they go by 
the name of epulis, distinguish themselves by their bluish color, 
(the result of an abundance of blood-vessels,) and not unfre* 
qnently contain osseous nuclei ; they are with difficulty removed 
completely, and hence apt to cause local relapses ; in more aged 
persons they may sometimes also paes into cancroid tumors* 

The sarcoma of lymphcUic glands^ the scrofulous sarcoma 
(Langenbeck), also belongs in most cases to the firm sarcomata. 
It begins as a hypertrophic swelling of several groups of lympha- 
tic glands, at first or altogether confined to one region only, 
especially on the neck or in the axilla. It always affects young 
individuals, partly scrofulous, but partly also persons apparently 
quite healthy. While at first, the several knotty, kidney-shaped 
lymphatic glands are plainly distinguishable, they gradually unito 
into a firm tuberous convolution, and in spite of all anti-scrofu- 
lous and resorbent remedies the neoplastic process advances in- 
cessantly. If it is confined to one part, e. g,^ to one side of the 
neck, the tumors become so much the larger ; if such formations 
are found at many points, e, ^ ., on both sides of the neck, in 
both axillso, both inguinal regions, in the abdomen, eto., the in- 
dividual tumors do not grow so large. They sometimes ex- 
ceed the size of a man's head. They are perfectly indolent and 
usually do not soften. If confined to one part, the tumor may 
finally cease to grow and can be extirpated with success ; but I 
know of very few cases where such a cessation occurred in the 
general process that evidently lies at the bottom of this. Most 
end fatally ; the gland- like tubers spring up like mushrooms in 
all possible parts of the body, at last, too, in. internal organs ; 
liver, spleen — Virchow ;) finally, marasmus sets in and the pa- 
tients die. On a section, the tumors look yellow, like glue, and 
take a darker hue in the air ; from the homogeneous cut surface 
an opaque serum can be expressed. Only in small children have 
I seen a metamorphosis and softening of these tumors into per- 
fect medullary mass. Continued use of iodine favors the soften* 
ing of these tumors and accelerates death, and yet we htirdly 
know what other remedies to apply. The prognosis of these tu- 
mors is evident from the described course. 

5. By soft {^^breiige^^ — ^pultaceous ) aarcomaia^ I mean such as 



Ckusificaiion qf Tumors. 848 

consist of a greyish-red, grit-like, granular, soft palp, surround- 
ed with firm, tongh connective-tissue capsules ; the surface of the 
unopened tumor is tuberous ; close to one tumor arises another, 
and so on ; the whole conglomeration, however, can be accurately 
enucleated from the neighboring tissues, which it pushes aside 
and causes to be resorbed ; although all this can usually be seen 
only in the extirpated specimen, because the softness and brittle- 
ness of the tumor when once cut into in operating renders it often 
very difficult to perceive its limits daring the course of the opera- 
tion. 

As a prototype of this not very frequent form of tumor most 
of the pseudoplasms of the salivary glands may serve, which com- 
monly, when not combined with cartilaginous or fibrous sub- 
stance, present themselves as soft sarcomata, in which the pulp 
may be so soft as to communicate to the previously examining 
finger the distinct sensation of fluctuation, and the tumor, after 
being opened, might well be mistaken for an atheroma, from 
which it differs, however, by the often very complicated organisa- 
tion of its tissue. With these tumors the sack must always be 
extirpated, for otherwise relapses will be sure to follow. When 
the tumors develop in aged persons, there is no security against 
repeated local relapses even after radical extirpation. 

On fasciae and the sheaths of tendons, also, these soft sarco- 
mata occcur, but generally combined with medullary tissue ; I 
have seen such tumors, though with partly medullary character, 
in the bend of the elbow and on the hand ; in the former case, 
the disease having until now returned locally four times, each 
time after a thorough radical extirpation. The more these tumors 
assume the medullary character and the sooner they ulcerate, the 
more pernicious are they ; their progress is very much slower 
than that of medullary tumors, although they perhaps always be- 
come medullary in the end, and destroy life by metastasis to in- 
ternal organs. 

6. Soft Papillary Tumors^ Villous Tumors^ Villous Can- 
cerSf Condylomata. — They are the same on mucous surfaces, as 
the horny excrescences on the cutis. The acuminate and the 
broad condylomata'*' are papillary prolifications of the mucous 

* German authors apply the name condylomata lata to the syphilitic "plagues 
muqueu»e9» and designate as c. ocitmffkita the (non- syphilitic) " condylomt*** 



844 Claas^fication qf Tumors. 

membrane, which, as is well known, develope more especially at 
those points, where the external skin passes into mucous mem- 
brane ; t they pertain ezclasively to the syphilitic process. Be- 
sides, villous excrescences occur on the mucous membrane of the 
nose, of the urinary bladder, on the gums (very rarely), and on 
the mucous coat of the stomach. In all these latter cases, how- 
ever, the villi do not constitute the only morbid product, but they 
are lodged either upon the substance of a tumor, or upon a tissue 
which underwent a morbid degeneration. This tumor -substance 
almost invariably bears a cancroid or even medullary character, 
and thereafter must be determined our prognosis ; usually these 
villous cancers, which operate destructively alike upon the surface 
and in the depth, not only possess in a considerable degree the 
power of returning locally — especially as their extirpation can 
hardly ever be made radical — but the nearest lymphatic glands 
also are not un frequently affected; yet they are but seldom fol- 
lowed, as far as my experience goes, by internal metastases, the 
cause of which partly lies in the dangerousness of the localities 
where these tumors develope. 

III. TUMORS WHICH ALWATS BKTURK LOCALLT, THEN APPEAR m 
THB NBARB8T LTMPHATIO GLANDS, AND FINALLY IN INTERNAL 
ORGANS. 

This group of tumors contains that which has ever been called 
Carcinoma and Scirrhus. In modern times the Cancroids, or 
epithelial cancers, have been separated from the carciuomata ; they 
possess, in fact, many characteristic traits even in clinical respect, 
so that we have to consider the following three forms of tumor : 

1. Carcinoma {carcinoma simplex — ^Foerster). — ^It is found 
especially in the mamma, and occurs ordinarily in women between 
thirty and sixty years of age, seldom sooner, but not so seldom 
later, A hard node — painful often from the beginning, in other 
cases not till later — develops in the mamma, at first slowly, then 
more and more rapidly. The swelling soon becomes immovable, 

of the French. (Cf. Virebow'a Cellular Pathology, tr. by Chance. London, 
1860 ; note on page 245.) The author's assertion at the end of the above sen- 
tence probably has reference only to the broad condylomata. — Tiu 

t Broad condylomata have recently been found in the larynx also.' (▼• 
DeuUche Klinik, 1860, No. 48$ and Yirchow's Archiv. xr. 4Q2.)s-Ta. 



Classification of Tumors. 846 

coalesces with the pectoral muscle and with the skin, and grad- 
Qallj extends more and more, new nodes being continually added 
to its periphery. Fleshy and lean, married and unmarried, feeble 
and healthy, poor and rich women, with or without children, all 
are in like manner exposed to this disease. When the tumor has 
invaded the vicinity of the nipple, this is drawn inward ; some- 
times it secretes a serous or sangainulent fluid. Soon after this, 
swellings appear in the axilla, which rapidly enlarge and are always 
larger than according to the examination they seem to be ; seldom 
the cervical glands are affected. Usually only one breast is dis- 
eased. In other cases, the entire mamma begins to swell, grad- 
ually becomes hard as stone, the skin thick, (edematous. Blue 
yeins, however, may traverse the skin in all anywise large and 
firmly coalesced tumors of the breast ; they are no sure sign of 
carcimona. In still other cases, a movable, painless tumor has 
long existed, but afterwards begins to pain, to grow more rapidly 
and to become immovable ; the glands in the axilla now swell, 
and the tumor formerly diagnosticated as adenoid tumor, turns 
out to be carcinoma. I have never seen, that women under the 
influence of this neoplastic development had been materially affect- 
ed in respect to their general health, up to the described stage of 
the process ; they suffer nothing but the lancinating pains, occur* 
ring particularly at night, but which are usually tolerable, and 
the tumor, although often very extensive in breadth, seldom ob- 
tains in this (not yet softening) stage the size of a child's head. 
Hence all things indicate, that hitherto we had before us a local 
affection ; thus it is regarded in modem times by most authors. 
This mode of view is very important in reference to therapeutic, 
and especially operative action, as we shall see below. 

In the operation of these tumors, more even than in the previ- 
ous examination^ we perceive that the tumor cannot be enucle- 
ated from the tissue of the mamma and extirpated alone, but that 
a part of the healthy structures must be removed with it, in order 
to take away with certainty all that is morbid. The examination 
of the specimen further shows that the diseased tissue is pretty ac- 
curately marked against the normal, but both are so intimately 
united one with the other on their borders, that even in the re- 
moved specimen they cannot be separated. The form of the tu- 
mor is very uneven, especially on the periphery : a multitude of 



846 Classification of Tumors. 

processes, appendices, white ramifications enter the adjacent fat, 
and if the skin is not yet entirely coalesced with the carcinoma, a 
number of white cords often mn towards it. This mode of con- 
nection of the tnmor with the adjacent tissue is to me one of the 
chief criteria of carcinoma. Catting into the tnmor now, we 
find the surface of the out of a light, pale-reddish color, granu- 
lar ; pressing it or drawing the scalpel across it, we see a soft 
milky pulp expressed from it. Sometimes the cut surface pre- 
sents yellow anastomosing figures, looking cheesy like tubercular 
matter ; they are masses of cells, undergoing tubercular or fatty 
degeneration, and have, according to my experience, no especial 
influence on the prognostic importance of the tumor ; J. Mueller 
has advanced a separate species of carcinoma after them, the 
xarcinoma rettctdare ; we mention this only in deference to the 
unsurpassed anatomist and physiologist. 

If the carcinomata are not extirpated in this stage, one tuber 
now begins to become more prominent, the skin on its apex is 
traversed by fine, very narrow, bluish- red vascular anastomoses, 
becomes shining, very tense and finally ruptures with a fissure, — 
or a vesicle arises on it, with whose rupture the first excoriation 
manifests itself. The prominent knot, while pressing forward, 
has become very soft, almost fluctuating, and the pains in it are 
sometimes pretty severe. If the tumors are operated upon in 
this stage, the soft tubers are seen to consist of a white medullary 
mass, that evidently resulted from the carcinoma, (usually, as 
we know from the microscopical examination, by rapid molecular 
disintegration and fatty degeneration, and also by an abnormally 
rapid increase of the cells.) 

The excoriation on the softened point, small at first, rapidly 
extends in surface ; no sooner is the very thin cutis destroyed 
than' the soft pseudoplastic masses burst forth and a fungous 
ulcer is formed, with an ichorous discharge. If the softening 
still remains localized for a time, the ulceration remains the same ; 
the white, fungous, luxuriating substance sloughs off gangrenous, 
and a crater- shaped or at least excavated ulcer, with rampart-like 
elevated margins, results. If the softening spreads rapidly, the 
ulcer also becomes large and larger, while at the same time the 
tumor gains in circumference and depth. Although the fungous 
walls around these ulcers are pretty high, yet they seldom acquire 



Gasiificaium of Tumors. 847 

such a sise as in an ulcerating primary medullary tumor. In 
this stage the patients suffer less from pain in the tumor than 
from the dreadful ichor the ulcerating surface secretes ; hemor- 
rhages, that often occur without any cause whatsoever, sometimes 
after a slight friction or blow, consume the strength of the patient 
more and more rapidly. The increasing swelliDgs of the axillary 
glands gradually coalesce with the mammary carcinoma, and the 
ulcerating surface extends upon them also. Violent neuralgic 
pains in the respective arm, intense oedematous swelling of the 
same, — consequences of the compression of the nerves and veins, — 
increase the sufferings of the unfortunate patients, for whom there 
is now hardly any other remedy than morphine, and morphine 
again. 

This highest degree of local development of the carcinoma is 
not brought about, however, in all patients. The consistent pro- 
gross of the carcinoma in depth can lead to the destruction of 
the ribs, finally to a perforation into the cavity of the pleura, and 
the patients have the good fortune to die of pleuritis ; but some- 
times not even this is granted to them : while the carcinoma in- 
creases in depth, a lingering local adhesive pleuritis is already 
established and the carcinoma passes into the lung without endan- 
gering life. Finally, the strength fails, which for an astonishing 
length of time resisted the ichorous discharge of an enormous 
Q^iellergrossen?^ — of the size of a plate — Tr.) ulcer, and the 
patients die of exhaustion. In still other cases, the local affec- 
tion obtains only a very limited extension ; soon emaciation comes 
on, pains in the hepatic region, icterus, slight pleuritic irritation, 
sometimes chills with irregular intermissions, sweats, pains in the 
joints, a continued fever, — in short, symptoms as in a slow pyae- 
mia, an eminent emaciation in a short time, horrible disfigurement 
and distortion of the features ; in otherwise robust individuals 
the termination is long delayed, to the horror of their friends, 
until finally the often implored death relieves the sufferers of their 
unspeakable distress. It is always melancholy for the physician 
to look upon patients with incurable chronic affections without be- 
ing able to help otherwise than by a permanent alliance with the 
. brother of Death, Sleep, artificially induced by narcotics ; but 
yet the last end of phthisical patients has always been to me 
rather less terrible than that of carcinoma patients. Both dis- 



848 Classifieatian qf Tumors, 

eases are extremely popular, and although one endeavors to con- 
eeal from the patients the nature of their affection, they usually 
do know it nevertheless. The good humor of phtlusical patients 
is well known ; a patient with carcinoma, but especially a woman 
with carcinoma of the breast, accurately observes her state, from 
the appearance of the first tubercle of the mamma forward, and 
she is much more conscious of the frightful knowledge that she 
is affected with an incurable evil, than a phthisical subject, and 
this knowledge becomes more and more prominent, particularly 
towards the end of the disease. Suicide in a consumptive pa- 
tient is something very rare ; in those with carcinoma it occurs 
more frequently ; it is not without danger to allow passionate, ex- 
citable men distinctly to perceive that they are incurable. I wit- 
nessed a case, where a patient with carcinoma of the lower jaw, 
not susceptible of an operation, shot himself when he was con- 
vinced that he could not be operated upon, although he was, as 
far as possible, put off with the encouragement to be patient and 
to hope. 

Let us now turn to the post-mortem appearances, which pre- 
sent themselves in subjects tho victims of carcinoma. Sometimes 
we find no tumors at all in internal organs, particularly when the 
local process had been very extensive and death resulted from the 
ulceration and the exhaustion of the vital powers. In other cases 
of mammary cancers, carcinomata are formed in the liver espe- 
cially, and that too often to a large extent ; also in the lungs and 
upon the pleura, where they not unfrequently have the character 
of cicatrix-like white streaks ; sometimes, finally, in bones. All 
these secondary carcinomata present themselves as soft white 
tumors, as medullary fungi; the firm granular carcinoma, as 
we have just described it in the mamma, does not easily occur 
in internal organs, whether primarily or secondarily. Hence we 
see that tumors of medullary character can combine with car- 
cinoma, partly arising out of the latter, partly accompanying 
it in other organs, — just as different forms of sarcoma may be 
followed by medullary tumors. Nevertheless the medullary tu- 
mor must be separated from the carcinoma, because there are 
tumors which from the beginning are purely medullary, and 
ijsually, too, take a somewhat different course from that of carci- 
nomata ; when the latter soften down to a medullary mass, they 



Clanificaiion of Tumors. 349 

thereby aeqaire also the elinical properties of medullary tumors, 
i. e.y they attack internal organs with great certainty and rapid- 
ity. Concerning the duration of carcinomata of the breast, this 
is very Tariable, the average being from about two to two and a 
half years : I believe to have observed that the course is the more 
rapid, the younger the individuals are and the further the softening 
has progressed ; but many cases cause the observer to doubt such 
general prognostic signs very much. I have seen the case of a 
woman of twenty- four years, who died after the extirpation of a 
still hard carcinoma, as large as a hen^s egg, of six months' 
standing, and where several tumors already existed in the liver ; 
and other cases, where in older women with fungous, ulcerating 
carcinomata, the first development of which occurred five or six 
years previously, no secondary cancers were found at all in the 
posi'fnortem examination. But, on the whole, these are excep- 
tions to the usual course. 

As to carcinomata in other parts of the body, they are very 
rare in the subcutaneous cellular tissue ; they occur in the upper 
maxilla with great capacity for local relapses and with tumors of 
the lymphatic glands on the neck, hardly ever attacking internal 
organs, but usually becoming fatal by ulceration, or by perfora- 
tion of the base of the skull. The carcinomata of the testicle 
are seldom observed as such, but usually as already softened, 
medullary tumors ; only when there is occasion to extirpate them 
when still very young, which occurs rarely because of the diflS- 
culty of diagnosis during the first beginning of an induration in 
the testicle, we sometimes find carcinomata, light yellowish-red 
and granular on a section, that distinguish themselves especially 
by a strong tendency to tubercular metamorphosis. In other 
cases, the tumor begins directly as a ineduUary fungus. Carci- 
nomata occasionally occur in many other localities, but the above 
are the most frequent. In the mamma, they often combine with 
scirrhus, of which more shall be said under that head. 

It seems to be doubtless, according to the observations now 
existing, that the predisposition for carcinomatous disease is he- 
reditary, although in a less degree in comparison to the predis- 
position for tuberculosis and scrofulosis. The being hereditable, 
however, is no proof whatever that carcinosis is primarily a gen- 



850 Class^fieaiion of Tumort, 

eral disease ; there are many loeal affections, €. g.^ moles, hare- 
lip, which are also hereditary. 

The qaestion, whether carcinomata should be operated upon, 
and when it is still prudent to undertake the operation, has been 
answered yery differently at different times. Starting with the 
opinion, that the first tumor is already the product of a general 
affection, which is presupposed to exist in the apparently healthy 
individual, one will be glad that the morbid matter has at last been 
localized, and will not extirpate the growth to avoid metastases 
to internal organs. The only observation that could be adduced 
in favor of this view, is, that sometimes the metastatic tumors 
are so much the less extensive the larger the primary tumor is. 
But this by no means always happens. Formerly, it was espe- 
cially urged in favor of this opinion, that the lymphatic glands 
swell more rapidly when the tumor was removed early ; this opin- 
ion, I believe, is based on doubtful observations ; for it is impos- 
sible to determine, whether small engorgements of the lymphatic 
glands did not already exist at the time of operating, inasmuch 
as, e. g.f in primary cancers of the mamma, the glands, which 
are situated underneath the pectoral muscle towards the fossa 
Mohrenheimiif cannot be felt in most cases, even if they have 
acquired double their normal volume ; one will be convinced of 
this when beginning to extirpate the axillary glands, — there seems 
to be no end of the packs of glands, they are more numerous 
than after the examination could be expected. I am therefore of 
the opinion, that the swellings of the lymphatic glands, which 
seem to develope particularly rapidly after the extirpation of the 
primary tumor in the breast, already existed previously to a great 
extent. That in ulcerating or in occult carcinomata so-called 
symptomatic enlargements of the lymphatic glands do occur, I 
by no means doubt ; observation often enough shows, that enor- 
mous ulcerating fungi exist somewhere on the body, while the 
lymphatic glands are not swelled in the least ; ulceration of car- 
cinomata and medullary fungi, by itself, does not create any 
sympathetic enlargement of the lymphatic glands ; wherever the 
latter exists, it already has the import of small cancers, even 
though — ^histologically — nothing carcinomatous can as yet be de- 
monstrated in them. 

The belief in the primary existence of carcinomatous disease, 



OasBifieation (/ Tumors. 861 

and in the development of the carttnomatotis tomor as the pro- 
duct of the former, has in latter days been placed in the back- 
ground. Unbiassed observation makes us perceive in most pa- 
tients with carcinoma, at first, nothing else whatever but the local 
disease. Persons of the most various constitutions, with the 
most various accidental chronic affections, may be attacked with 
carcinoma; tuberculous individuals, also, are not excluded, al- 
though less frequently affected by it ; there is no symptom of a 
general affection of the body, be it ever so slight, that were com- 
mon to all carcinomatous patients in the commencement of the 
disease. It is often enough found mentioned, a carcinomatous 
patient wore the expression of a deep* seated affection, a sallow 
complexion, that he was emaciated, with withered skin and mus- 
dies ; but all this is true only of the end of the disease ; in the 
beginning, we usually have before us healthy, often surprisingly 
robust persons, who present nothing morbid except their tumor. 
Hence the conclusion is near at hand, that first the tumor ^ and 
then the carcinomatous disease^ is developed. This view is con- 
firmed by accurately following up the course of the evil ; we see, as 
it were, how the local disease extends ; the adjacent parts become 
affected, then the glands, and only after this a general affection 
of the body is brought about. 

This last described view of the cancerous disease, which now 
probably is the most generally accepted, must in consequence 
lead to other therapeutic measures. The object is, as early as 
possible to destroy the focus, from which the infection of the 
lymphatic glands takes its origin, and if possible to remove these 
also in order to retard the infection of the body at large. I do 
not doubt but that the adjacent tissues and the neighboring 
glands are infected by the carcinoma by a sort of direct conta- 
gion, and that the infection of the fluids of the whole organism 
originates from the lymphatic glands, in which case, moreover, 
the contagious matter undergoes an often protracted stage of in- 
cubation ; but sometimes the contagious matter seems to be held 
completely back in the glands as by a wall ; on this subject we 
shall say more in connection with the cancroid. This course of 
the infection of the tissues and the organism is true, however, 
only in reference to carcinoma and cancroid, but seldom appli- 
cable to the medullary tumors and to the sarcomata, when these 



Classificaiion of Tumors. 

ocenr metastatic ; this is one reason also for separating the me- 
duUary tnmors from carcinoma, of which I shall likewise speak 
more fally below. 

2. 7%c Cancroid ( Tumor) — Carcinoma epifheliale — CauK" 
floufer- growth. — ^In general, all the more important points that 
we stated in;regard to carcinoma, are also applicable to the can- 
croid tamor, except that in patients who perish by it, tumors very 
seldom form in internal organs, since the great expansion of the 
local tamers and those of the lymphatic glands terminates life by 
its location and the destruction of parts necessary for life, as wett 
as by exhaustion of the strength. 

The seat of these tumors is more especially : 

(a) On the head and neck; namely, in the lower lip, the 
mucous membrane of the mouth, on the gums, cheeks, the upper 
and lower jaw, in the neck deep between the muscles, in the 
tongue, larynx, oesophagus, on the ear, less frequently on the 
scalp and forehead. Those who are attacked by it are particu- 
larly aged persons, most frequently individuals (especially men) 
between forty and sixty years old ; in some cases, also, I have 
witnessed in the 20th, 24th, and 28th year of age, already, enor- 
mous tumors of this kind on the tongue and lower- jaw. The 
tumor commences at first either as an indolent node in the tissue, 
or as an exfoliating excoriation, or as a warty excrescence; in the 
two latter cases soon associated with induration and rapid fun- 
gous ulceration. The bones, e. ^., the superior and inferior 
maxilla, can be totally infiltrated and destroyed by the cancroid, 
and no tumor of any considerable size be visible ; bu^the teeth fall 
out, and considerable pain soon manifests itself. The upper jaw 
is usually primarily affected ; the lower is oftener surrounded by 
the cancroid which takes origin from the gums and periosteum. 
Cancroids, which begun as «nodes, often exist on the neck and 
the tongue a long time before they ulcerate, but on the lip the 
ulceration appears soon ; the latter is generally very fungous. 
The exuberating mass here seems to possess a little more vitality 
than in the carcinoma. If the ulcerating surface be pressed later- 
ally, a number of white plugs can usually be squeezed out, as out 
of comedones. Lastly, even the hardest swellings of this kind 
may soften, while growing larger and larger, and this softening 
can advance to such a degree that the tissue is reduced to a 



Classificalion of Tktmors. 858 

pnrifonn, emulsiye fluid and the ulceration seems like the evacua- 
tion of an abscess. Hemorrhages from cancroids are less fre- 
quent than from carcinomata, yet the secretion is just as bad, 
and the ichorous discharge is usually tinged with blood. Pretty 
soon the submaxillary glands enlarge, and grow, as thick, knotty 
tumors, with astonishing rapidity, until they surround the neck 
from one side to the other and threaten to suffocate the patient. 
In this state the patients usually die of exhaustion, whether oper- 
ated upon or not, and when the post 'mortem examination is 
made, we find but very seldom tumors in internal organs ; that 
the latter occur at all, we only know from three cases reported by 
Yirchow. In twelve or fifteen cases of the kind, which I dis- 
sected, I have never found internal tumors. Nevertheless, the 
sufferings of these patients are not less fearful than of those with 
carcinoma. The certain, and often very rapid relapses after the 
^lecessary operations which sometimes hideously disfigure the 
face, and the enormous local development, usually accompanied 
by violent pains, are to the patient as well as to the attending 
physician more terrible almost than if there were hope soon to see 
the poor patients' sufferings ended by the formation of internal 
tumors ; but when the individuals are otherwise robust, as is gen- 
erally the case, the torture sometimes lasts dreadfully long. The 
whole tongue, the pharynx, upper and lower jaw, and the lym- 
phatic glands, all will join in one mass of tumor ; the patients can 
neither live nor die, and sometimes are condemned for months 
yet to lead a miserable life, half starving and half suffocated. 

{b) Another region of the body, which is most frequently vis- 
ited by the cancroid, is that ot the genital organs and anus. The 
cancroid tumor of the penis occurs in the shape oE condyloma- 
tous productions on the prepuce, or as an induration on the glans, 
and can attain enormous dimensions. On the scrotum it occurs 
especially in English chimney-sweepers, as so-called ^*chimney- 
sweeper's cancer," caused, it is said, by the soot of pit- coal. 
The cancroid ulcerations also spread upon the labia minora, 
clitoris, and from thence up into the vagina. More frequently 
than in all other localities, the cancroid is observed on the portio 
vaginalis uteris where it luxuriates in the form of warty, fun- 
gous excrescences, and secretes a sanguinulent discharge of pen- 
etrating, offensive odor; it is known under the name of cauli- 
Vol. XIX.— 28 



354 Classification of Tumors, 

flower- grotvth. The cancroid tumor of the rectnm, generally 
known as strictura carctnomatosaj in most cases attacks the 
entire circumference of the rectum, and is seldom confined to one 
or the other side. Imperceptible at first, it finally causes the 
most violent pains, usually ulcerates and is covered with fungous 
granulations, and afterwards extends to the bladder, the prosta- 
tic gland and the sacrum. It has struck me, that patients with 
carcinoma recti were aflfected at an especially early date with 
debility, emaciation and a sallow complexion. Seldom the anal 
orifice is aficcted, usually the cancroid begins from ^1-2 inches 
higher up. 

I believe that the experienced surgeon will agree with me, in 
asserting that the operation in the last named parts allows of a 
comparatively favorable prognosis, i. e., that the local relapses 
of a cancroid of the penis and the labia pudcndi, of a carcinoma 
recti, of a carcinoma epitheliale uteri, do not occur as rapidly as 
after the extirpation of the same tumors in other localities, pro- 
vided that the extirpation could be made complete. The swell- 
ing of the lymphatic glands, too, developes more slowly. All 
these patients finally die of the sanious discharge and the hemor- 
rhag^^s, but here also we hardly ever find tumors in internal 
organs. 

Finally, we have the cancroids in the integument of other in- 
definite parts of the body ; I have seen them extirpated from the 
hand, foot, and leg, but cannot state any thing more definite as 
to their course. On a section, the cancroid tumors appear per- 
fectly white and have a soft granular cut surface ; they can some- 
times be torn in certain directions, and, in drawing the scalpel 
over them, emit a milky, seldom an opaque mucous pulp. On 
the boundary of the heulthy structures, the cancroid substance is 
not seldom seen advancing into the tissues in the form of white 
pegs (^Zapfcn), Very fresh cancroids, and newly returned tu- 
mors, appear purely lardaceous, dark-yellow, with little serum 
on the surface of a cut. The fungous ulcerations sometimes 
present on their section a medullary character. 

3. ScirrhfiSy Fibrous Cancer^ j9trophying Cancer. — While 
in the beginning of this century the appellations scirrhus and 
scirrhous were still applied to almost all hard, chronic indura- 
tions, the capacity of this designation has now been reduced to 



Ctassifieaiion cf Tumors. 856 

one form of tamors, which, as far as my observations extend^ 
occurs only in the mamma and in the skin. 

The scirrhus of the mammay or the atrophying {atrophia 
rende)j cicatrizing cancer of the breast, is properly no tumor, 
but an indnration, with simaltaneous atrophy of the organ. It is, 
Eo to speak, the mildesD form of carcinoma — if all the tumors be- 
longing to this group may be designated as carcinoma, (carci- 
noma simplex^ epziheliaie, czcairicans.) The scirrhus develops 
mostly in lean women between fifty and seventy years of age. 
The already very atrophic, but soft mamma indurates at one 
point, and this indaration gradually coalesces with the skin, 
which is very much contracted in the form of a navel, and corru- 
gated like a cicatrix. Usaally the progress of this induration is 
accompanied by lancinating pains. Small, but very hard tuber- 
cles, of the size of a pea or bean, soon appear in the axilla, 
sometimes with contracting scars in the skin ; these can extend 
into the depth, so thac the arm becomes painful and cedematous. 
When in these indurations of the breast ulceration is brought 
about by epidermidal necrosis {Verschorfungen)y the ulcer 
remains flat and secretes little serum. The scirrhus in its purest 
form admits of a very passable prognosis, the patients, operated 
or not operated upon, may live for ten or twenty years after the 
development of the first induration ; and as this disease occurs 
only in aged women, most of them will die of other accidental 
diseases. Rirely the scirrlius remains in a pure form, but is com- 
plicated with carcinoma. While a part of the gland becomes 
scirrhous and atrophied, one lobule will give origin to a carcino- 
matous swelling, which then takes its usual coarse. Although in 
this case the infection of the body takes place far more slowly 
than in carcinoma, yet finally it runs its course, and a little later 
the patients do not escape their terrible end. After the extirpa- 
tion of the entire scirrhous, atrophied breast, sometimes no re- 
lapses occur at all, or else carcinomatous swellings are developed 
in the cicatrix or in the axillary glands at a very late period. 

In the examination of extirpated scirrhi of the marama, one is 
sometimes astonished, to what a minimum the whole gland, once 
so active, c:in be reduced ; in one case which I examined, .it 
scarcely equalled the size of a dollar (/Ao/fr). In the examina- 
tion from without (in situ — Tr.) one can form no very accnrai* 



356 Classification of Tumors. 

opinion of the degree of the atrophy, because an enlargement of 
the panniculus adiposus replaces the want of glandular sub- 
stance, and, in view of the age of the patient, the form still 
seems unchanged. 

The examination of extirpated scirrhi always shows, on a sec- 
tion, a preponderance of cicatrix- like tissue of the firmest tex- 
ture, grating under the knife (^cancer ligneux — Velpeau) ; near 
the nipple the larger lactiferous ducts sometimes remain dis- 
tinctly yisible as prominently marked white cords, or perhaps filled 
with a cheesy, granular, yellow pulp. Near them we not unfre* 
quently find a light brownish-yellow firm mass of a lardaceous 
gloss, that forms a knot on the margin, and from a cut surface 
of which a little serum only can be scraped off with difficulty. 
(Cancer lar dace — ^Velpeau.) From this yellow lardaceous in- 
filtration the scirrhus always, I believe, takes its origin, although 
we do not in all cases discover it in larger masses ; and it is 
probable also that from it a carcinomatous node may arise. It 
seems to me to be an ill-developed, yet never unsuspicious carol • 
nomatous infiltration, the presence of which in larger quantities 
should always lead us to suspect an inclination towards carcino- 
ma, and therefore, possibly, more rapid relapses. There is still 
another modification of the scirrhus of the mamma, which may 
occur when it affects the entire gland, or both, and especially the 
skin ; then innumerable, gradually coalescing, flat swellings arise 
in the skin, and the latter assumes a brown-rod color, shining as 
if indurated; without any very perceptible intumescence, some- 
times with violent pains ; the entire anterior and even the lateral 
surfaces of the thorax are surrounded as by an armor, {cancer 
en ctiirasse — Velpeau,) so that the rigidity of the skin (which 
may affect also the intercostal and pectoral muscles so as to result 
in their complete atrophy) can even disturb the respiratory move- 
ments of the thorax. In these cases an operative act must not 
be thought of. 

The scirrhus of the skin occurs likewise only in aged persons, 
and always appears as an ulcer. Usually it begins with a yel- 
lowish, exfoliating spot, sometimes with a low production of 
warts ; soon after, a small shallow ulcer is formed, with infiltra- 
ted, extremely hard margins ; this never extends much in depth, 
but expands in superficies. The base of the ulcer ordinarily is 



Classification oj Tumors. 867 

yellowish -red, smooth and shining, with a little serous secretion, 
sometimes a thin discharge forming scabs upon it. Pains are 
almost never present. Sometimes the ulcer cicatrizes spontane* 
ouslj on one side of the margin or in the centre, while in other 
directions it extends ; the increase of the ulcus rodtns or cancer 
culaneusj as this affection is customarily called, is slower than 
that of any other ulcer ^ in one case it had, in seven years, ac- 
quired no more than the diameter of one inch. Its principal seat 
is on the nose, glabella, forehead, in the temples, on the eyelids, 
cheeks and ear. Very seldom the affection is transferred to the 
lymphatic glands ; I have observed this only twice ; there is so 
little occasion to m^ke post-mortefji examinations of such per-* 
sons, that it is difficult to judge whether this form of scirrhus in 
the skin can become dangerous by infection of the body ; I be- 
lieve not. In one case, where death ensued upon the extirpation 
of such an ulcer, I found no tumors whatever in internal organs. 
I have long hesitated, whether it would not be better to designate 
it as lupus senum ; but yet the extremely slow course and the 
cicatrizing character of the ulcer, together with observations of 
cases where this disease was combined with cancroid tumor and 
accordingly took a more rapid course, induce me to consider the 
ulcus rodens as a true scirrhus cutis and to parallel it with the 
scirrhus mammaB.* After the extirpation, the pure, very dry 
cancer cutaneus but very seldom returns ; but if the walls of the 
ulcer were very thick and show a section like that of cancer, while 
in the simple cases they have a lardaceous aspect, a more rapid 
course may be prognosticated. 

If I may be allowed, at the end of this group, which unfor- 
tunately contains the most frequent tumors, to add a few gen- 
eral remarks on their operative treatment — I consider it as un- 
doubtedly correct, according to the observations we possess at 
present, to extirpate all carcinomata which can be radically 
extirpated without direct danger to the life of the patient. 



• Cf. the report of J. Hutchinson on forty-two cases of rodent ulcer in the 
Med. Times and Gazette} H. regards it as "very nearly allied to cancer," but 
would reject the name of "cancer of the skin/' and prefers to call it rodent 
ulcer. (Vid. Amer. Journ. Med. tic.^ January, 1861, p. 272.)— Tb. 



858 Oassification cf Tumors. 

If lymphatic glands are already swelled^ these must be extir* 
pated with them ; if this is impossible^ then indications for 
the extirpation of the primitive tumor are only exceptions^ 
such as violent hemorrhages^ excessive pains^ enormous dis- 
charge from the ulcer. In saeh desperate cases, we may some- 
times, by a — perhaps very bold — operation, obtain relatively 
favorable results. If the patients overcome the first shock of the 
operation, they sometimes begin once more to revive when freed 
from the carcass they carried with them, which excluded them 
from all human society by the pestilential atmosphere that always 
surrounded them. Here, in Berlin, where carcinoma patients are 
often sent whom one must regard as victims of death in a few 
weeks, I have witnessed examples of such patients leaving the 
hospital in the belief that they were completely cured. The new 
invigoration, it is true, does not last long ; yet it is always grati- 
fying in such a disease to be able to help for a time at least. 
Unfortunately, in most cases, where considerable irremovable tu- 
mors of lymphatic glands already exist, the primary carcinomata 
themselves no longer admit of an operation. Then, a local rem- 
edy remains to us, namely, the fert-um candensy which in these 
very cases sometimes has wonderfully beneficial effects, and, for 
the weal of the unlucky patient, should never be neglected, but 
used to afford him at least some temporary relief by the destruc- 
tion of the ulcerating pseudoplasm. / regard it as a duty 
earnestly to advise every patient with a removable cardno* 
ma or cancroid in favor of operation^ and I regard it as 
harmless also to remove a scirrhus of the breast or skin at 
the request of the patient, if the latter is not too old, and 
otherwise of a strong constitution ; for, to very aged persons, 
a simple confinement to bed for some time is not without danger. 
I would not advise the operation of a scirrhus, and would extir- 
pate it on the face only when it is possible to do so without a 
consequent extensive plastic operation. Such operations SQme- 
times indeed succeed unexpectedly well, but an old withered skin 
does not bear any great locomotion ; union by first intention fre- 
quently does not occur, the wounds heal slowly, and the patients 
suffer for an unproportionally long time after the operation. 
Here it depends altogether on the individuals and on the seat of 
the disease. Experience from a greater number of oases, only, 



Classifieaiian of Tumors. 869 

will indicate the final decision as to what to do and what to leave 
undone in the individual case. 

rV. TUMORS WHICH USUALLY SOON RBTURN LOCALLY, AND RAPIDLY 
EXTEND UPON INTERNAL ORGANS. 

1. Medullary Tumors y Medullary Sarcomata^ Medullary 
Carcinomata — Fungi Medullar es (Encephaloid — TV.) — By 
these names, we designate tumors of a very soft consistence and 
an encephaloid appearance on a section. The color may be 
changed by gangrene of the substance of the tumor or by extra- 
vasations of blood ; but originally the tumors are of a pure white 
color, usually very deficient in bIood< Seldom only an espe- 
cially prominent production of vessels combines with their develop- 
ment, so that the tumors obtain a blood- red color, (fungus 
hxmatodesy) and then, of course, the similarity to the substance 
of the brain disappears. 

I find that, aside from their anatomical distinction, these me- 
dullary tumors present so many differences from carcinomata, 
that I have therefore separated the two altogether. Various sar- 
comata, adenoids, carcinomata, can combine with, or be trans- 
formed into, medullary fungus, but there is also not an inconsid- 
erable number of cases, in which the medullary tumor appeared 
primarily as such. I will endeavor to characterize these cases in 
the following : 

The medullary tumor is developed only in young persons and 
children, from the first to, at most, the fortieth year of life, most 
frequently between the tenth and twenty-fifth. Generally, per- 
fectly healthy persons are affected, but emaciation and the ex- 
pression of a serious affection sometimes make their appearance 
after a short time already. The most frequent primary seat is 
the bones and periosteum : femur, tibia, especially the knee-joint, 
more rarely the region of the hip and the tibio- tarsal joint, the 
tarsal bones, the hand, forearm, scapula, upper maxilla, and 
cranial bones. Fasciae and the sheaths of tendons, the subcu- 
taneous cellular tissue, and the muscles, are likewise fit ground 
for medullary tumors to grow upon. In the testicles, also, and 
in the mamma, the medullary tumors occur; seldom in the rectum 
and the neck of the uterus. They grow very rapidly, the skin 



860 ClaBBificaiion of Tumors. 

covering them soon becomes red, and flnctnation appears very 
distinctly, so that the mistaking it for an abscess is excusable. 
With the increase of the tumor the skin gradually becomes thin- 
ner and soon begins to ulcerate. Now the tumor grows more and 
more rapidly, the new-formed masses sprout forth in abundance, 
and are laid over the sound parts like mushrooms. The fungus 
assumes on the surface a blackish- green color and secretes little; 
but small shreds of gangrenous tissue are continually sloughed 
off. If the tumor be examined after the extirpation or the am- 
putation of the respective limb — (a resection can but very seldom 
supply the place of the latter, on account of the accompanying 
considerable destruction of the soft parts) — the diseased parts 
are generally found separated from the normal by a sort of cap- 
sular investment of the fungus, like a sarcoma, to which it pre- 
sent? more similarity in this respect than to carcinoma. Very 
rarely the respective lymphatic glands are swelled in cases of 
medullary tumors ; in many instances they are not enlarged at 
all during the entire course of the disease, but they can also be- 
come the seat of a relapse, unless — which is more frequently the 
case — the tumor returns on the stump or in the cicatrix, often 
while the wound is still in the progress of healing. Cases occur, 
in whi^h after the firsr or second operation the morbid process 
makes a pause of some months, and the patients regain their 
strength surprisingly ; one is in hopes to have been mistaken in 
in the diagnosis ; but afterwards these patients also soon perish 
by it. Usually, signs of the formation of tumors in internal or- 
gans occur already, while we are yet considering whether a sec- 
ond operation is practicable. The ulceration of the external 
relapses accelerates the decline of the strength, and the patients 
sink rapidly, until death relieves them of their sufferings. The 
mean duration of the whole course of the malady is from one to 
one and a half years. In case of medullary tumor of the testi- 
cles, the retroperitoneal lymphatic glands almost invariably be- 
come the centre of development of enormous secondary tumors. 
Tumors of this sort in bones not unfrequently omit to touch the 
lymphatic glands in their further progress, and nearly always 
cause metastases in the lungs. The primary medullary tumor in 
bone is not seldom traversed by osseous spiculae, especially if it 
arises from the periosteum of the tibia or femur. 



Classification of Tttmors. 361 

Inasmach as the general itkfection of the body, with these ta» 
mors, can ensue without the lymphatic glands being affected, as 
has been observed, one might much sooner consider the dyscrasia 
as the primary affection in these than in the case of carcinoma ; 
yet, when seeing patients with medullary fungi, and having oc- 
casion to notice that, in spite of largely developed tumors, they 
have a fresh, flourishing appearance, I believe one will incline as 
well towards the opinion, that the tumor itself is the focus, from 
which the contagion gradually radiates over the body. Medullary 
tumors also occur congenital, e» g.^ as ttttnores coccygei. 

The powers of combination of the medullary fungi with other 
tumors are very manifold. In the testicle, ovary, and mamma 
particularly, the most various tissues, especially cysts, cartilage, 
bone, muscular fibres, etc., are developed in connection with me- 
dullary tumors, The most frequent combination is, as we have 
repeatedly stated, that of carcinoma or cancroid tumor with the 
encephaloid, the former assuming the character of the latter ; the 
prognosis then holds a mean between the two forms, but there is 
so little room for a differeuce between the prognosis of the one 
and the other, that it can only be stated as a general proposition, 
that tumors combined with medullary masses allow us to expect a 
more rapid general infection, while in case of pure carcinoma or 
cancroid we must rather count upon the local development and 
tumors of lymphatic glands. 

2. The Melanotic Tumors^ Carcinoma MelanodeSj Ma* 
lign Melanoses, — The tumors are easily recognized by their dark 
bluish or brownish -black color. We exclude, for the present, 
the congenital, so-called liver- spots and the larger pigmented 
moles ; and the yellow and orange pigmentations of soft earco* 
mata, c&used by extravasated blood, are also omitted here ; but 
we understand by melanotic tumor one which is remarkable for an 
intense dark pigment, developed at the same time with the new- 
formed tissue. Tumors of this sort are not frequent, and usually 
commence as a black spot, appearing like an ink-stain, or as a 
circular piece of skin painted with sepia. This spot gradually 
becomes elevated, a more or less prominent tumor, which, how- 
ever, expands principally in surface, sometimes by the formation of 
new isolated spots around the first tumor. Soon the black growth 
begins to ulcerate, now extending more as a shallow ulcer, now 



862 Cla9sification of Tttmors. 

as a fangons excrescence. The Tayorite seat of these black tn- 
mors is the skin and subcotaneons tissue, particularly on the feet 
and hands, but they also occur occasionally in many other places, 
on the skin of the chest and abdomen, in the axillary glands and 
the testicles, rarely in the mammary gland. 

Another mode of deyelopment of melanoses is that from pig- 
mented moles ; a liver-colored or black mole gives rise to itching, 
is therefore scratched, begins to form a scab, enlarges and grad* 
ually becomes an ulcerating tumor. This has been repeatedly 
observed by Langenbeck, and I have once seen this mode of de- 
velopment myself. 

The extirpated tumors are soft, externally of a dark-bluish, 
internally of an intense bluish-black or brown color ; the surface 
of a cut yields a fluid that could be used for painting, like sepia. 
Spread on paper in a thin layer, it has a light- brown color, and 
preserves for many years. In some cases, we find in the inte- 
rior of the tumor partly a soft black mass, partly white medul- 
lary substance, sometimes also in part a substance of rather light 
brownish color. The black spots in the skin appear on a section 
as a simple line ; they do not extend far in depth. The tumors 
are by their very color limited precisely against the normal 
tissue. 

The course that melanotic tumors run, has the greatest similarity 
to that of the medullary fungus, only that it is sometimes still 
more rapid, and that, in general, the black tumors occur in older 
persons, at least beyond the 30th year of life. Primary pure 
and complete melanoses are followed secondarily by the same 
tumors ; if the primary tumor was melanotic only in part, the 
secondary growths may be perfectly medullary, white. Peculiar 
to the melanotic tumor is an often extremely numerous distiibu- 
tion over the entire surface of the body ; hundreds of black spots 
or bluish swellings may arise in the subcutaneous tissue in such 
an extent, as otherwise hardly ever occurs in carcinomatous or 
medullary tumors. 

The question, whether intercourse with patients suffering from 
carcinoma, cancroid, scirrhus, medullary cancer or melanosis, 
can act contagiously upon healthy persons, must be negatived 
emphatically. Another, as yet little ventilated question is, 



Classifieation of Tumors. S63 

whether the said tnmors are inoculable. This has so little prac- 
tical value, except perhaps in regard to carcinoma uteri and 
carcinoma penisy that it has seemed little called for to make 
experiments on this subject. I have twice inoculated the ears of 
rabbits with the fresh, warm juice of melanotic tumors, but up 
to three weeks after the operation nothing was visible. Locally^ 
there was not the slightest reaction ; and in the dissection of the 
animals, which I used for other investigations, nothing abnormal 
was found. These experiments, however, even if they were made 
more extensively and always with negative results, could only 
prove that the cancer of man cannot be inoculated upon animals. 
Moreover, it must be taken into consideration, that even if the 
matter does take effect, a longer stage of incubation must be 
waited for. It would not be uninteresting to pursue these exper- 
iments on animals still further. 

The classification of tumors herewith concluded, has, like every 
essay of this kind, its great imperfections, I well know; but as 
the above synopsis corresponds to observation and to practical 
wants, as I hope, it thereby accomplishes that purpose, which 
every classification of diseases can only have, namely, to facili- 
tate the mutual understanding of colleagues. Many will reject 
the principle of classification ; I am aware myself, that much 
can be said against it ; but that for practical medicine, without 
detriment to science, the practical points of view, i. e., those 
derived directly from clinical experience, the observations at the 
bedside, must always be placed in the foreground, — is a princi- 
ple the physician should never lose sight of. I believe, that it 
will favor the popularity of the four groups advanced by me, to 
add to each group a general name. I have no new names to 
suggest, but only propose to apply the old names in the man- 
ner as they are used in the following synoptical table, with refer- 
ence to the above detailed remarks : 

1. Benign Tumors; i. e., such as but seldom return after 
extirpation^ but sometimes occur distributed in great num- 
bers over the whole surface of the body. 
1. The simple Cysts. 

(a) With serous fluid. 
(6) With mucous contents. 



364 Cla$9iJieation of Tumors. 

(c) With pnltaceons contents. 
(4) With blood. 

2. The Fatty Tamors. 

3. The Fibrous Tumors. 

(a) The soft fibrous tumors. 
(6) The hard fibrous tumors. 

4. The pure Cartilaginous Tumors. 
6. The Exostoses. 

(a) The spongy exostoses. 
(6) The ivory exostoses. 

6. The Vascular Tumors. 

(a) The telangiectases. 

(6) The cavernous hsematomata. 

7. The Horny Excrescences. 

II. Sarcomata; — Tumors which often return hcalit/j but 
seldom invade the internal organs. 

1. The Gland-like Tumors. 

2. The Colloid Tumors. 

(a) The homogeneous colloid sarcomata. 
(6) The areolar colloid tumors. 

3. The Cystoids and Cystosarcomata. 

4. The firm Sarcomata. 

5. The soft Sarcomata. 

6. The soft Papillary Tumors. 

ni. CARcmoMATOUS TuMORS ; i. e. , such as always return 
locally^ then appear in the nearest lymphodic glands^ and 
finally in internal organs. 

1. The Carcinomata. 

2. The Cancroids. 

3. The Bcirrhi. 

IV. Medullary and Melanotic Tumors ; i. e., such as usually 
soon return locally ^ and rapidly extend upon internal or- 
gans. 

1. The Medullary Fungi. 

2. The Melanotic Tumors. 



On the TVeahnerU of Hmmorrhoids, 865 



PART III. 

RECORD OF MEDICAL SCIENCE. 



On the treatment of Haemorrhoids. By MM. Nklaton and 

Hbtfblder. 

In a recent clinical lecture, M. Nelaton made the following re- 
marks : — ^' I was some time since a great partisan of the actaal 
cautery in haemorrhoids, at le&st since it could be eifl ployed un- 
der conditions formerly impossible. In fact, nothing can be more 
painful than its application. I have seen cauterization employed 
many times by Dupuytren, who first excised the tumor and then 
cauterized; but so terrible were the sufferings of the patients, 
that I could scarcely have made up my mind to have recourse to it, 
had not the means of preventing pain by chloroform been discov- 
ered. I have since then frequently had recourse to cauterization 
with the best results ; and if I do not employ it now it is because 
we have at our disposition another operative procedure which is 
just as good, and which is not painful either during or after its 
application. I mean ecrasement lineaire. It is usually unat- 
tended with haamorrhage, and when, as is sometimes the case, 
there is a certain amount of bleeding, this may at once be arrested 
by means of a powerful haemostatic, the perchloride of iron. The 
union of these two means, then, constitutes an excellent method 
for the ablation of haemorrhoids. 

<^ One word about ligatures. All surgeons at the end of salt 
century and the beginning of the present were very fearful of ap- 
plying ihem, owing to an instance of fatal haemorrhage which oc- 
curred after the application of the ligature by J. L. Petit. I be- 
lieve I am right in afiSrming, guided by the cases related by Amus- 
sat, and by those which have occurred in my own practice, that 
these surgeons entertained the most erroneous notions concerning 
the results of the ligature employed for haemorrhoids. It is an 
excellent operation, by means of which patients may be cured in 
eight or ten days without any accident ; and indeed I may place it 
on the same line with ecrasemenl iineaire. The latter has, how- 
ever, the indubitable advantage of causing the fall of the tumor 
within a few minutes, although perhaps it offers somewhat less 
security against haemorrhage. 

*' There is one thing to be well borne in mind — viz., that all 
these operations practiced in the vicinity of the anus, however 



366 Oh ihe ireatmenl of Hmmorrhaids. 

simple they may be in appearance, may terminate in a fatal man- 
ner. This is a powerful motive for insisting as long as possible 
on palliative treatment, only performing an operation as a last re- 
sort. Quite recently, one of oar leading sargeons applied a small 
portion of Vienna caustic to a hemorrhoidal tumor, Mid the pa- 
tient was dead the next day ; while in another case, an incision 
made into fistula scarcely a centimetre in length, was followed in 
a few d&ys by fatal purulept infection. I was myself consulted 
some years since by a man who, having acquired great wealth, 
complained bitterly of not being able to enjoy it in consequence 
of a bsemorrhoidal tumor. I advised him to bear with it, but 
some time after abundant haemorrhage having come on, he en- 
treated its removal. He manifested all the signs of complete 
anaemia. He was put under the influence of chloroform, and the 
actual cautery was employed. He did not suflfer daring the oper- 
ation, but scarcely had he recovered consciousness when he com- 
plained exceedingly. I appeased the pain and all seemed doing 
well, when on the sixteenth day violent shivering ushered in pur- 
ulent infection, and he died. The conclusion to be drawn from 
all this is, that jou should never operate except when you cannot 
possibly avoid doing so, since when you least saspect it you may 
meet with sinister events similar to those just adverted to. 

*' One more word with respect to ecrasement fineaire. This 
operation has during some time been frequently resorted to ; and 
it is for this description of tumor it is perhaps best adapted. But 
I ought to inform you that in most cases the operation is badly 
executed. For a short time after its performance the patients are 
delighted, and the surgeon believes that he has attained a splendid 
result; but in the course of a few months the cicatricial tissue 
contracts, and the patients suffer from an anal stricture. During 
about a twelvemonth I have had a great number of patients who 
come to me in order to undergo an operation for the relief of this 
unfortunate consequence of removal of hseinorrhoidal tumors — 
the stricture sometimes scarcely admitting the passage of a quill. 
It has arisen because not only the mucous projection which alone 
constitutes the disease has been removed, but also a more or less 
considerable portion of the skin of the orifice of the anus." 

[Professor Heyfelder, of St. Petersburg, commenting upon 
the above article (Deutsche Klinik, No. 20,) adds some corrobora- 
tive instances of fatal results speedily following apparently trifling 
operations in the anal region. He is inclined to regard such cases 
as examples of irritation of the nervous system, somewhat anal- 
ogous to the delirium nervosum or fraumaiicum met with after 
injuries ; and this the more so, as such excitement is often mani- 
fested in persons suff'ering from haemorrhoids, owing doubtless to 
some extent to their want of rest.] — Brif, and For » Medico- 
Chir. Review. — Pacific Medical Journal. 



Smiihianian Inaiiiutionj tfc. 867 



Smiihsonian Insiiiuiion. 

The total amoant of the bequest, as received into the treasury, 
was $515,169 ; interest on the same to July, 1846, devoted to 
the erection of the building, (242,129. In addition to these 
$135,000 of unexpended income has been invested in State 
bonds, so that the present income of the Institution is $38,325.- 
14. The principal expenditures are, for salaries, about $9,000; 
for publications of ail kinds, $9,000 ; for meteorological obser- 
vations, $2,500; for lectures, $1,000; for the library, $3,500 ; 
for museum, $2,000. There are some incidental matters involv- 
ing expenditure, and about $5,000 is set apart from the income 
to make a certain financial change for the sake of economy. The 
collections of various kinds which had accumulated at Washing- 
ton, have now been concentrated at the Institution, Congress 
agreeing to make an appropriation of $4,000 annually to keep 
them up. They are such a? the collection of the Exploring Ex- 
pedition, under Captain Wilkes, in South America and the South 
Seas ; that of Lieutenant Herndon's exploration of the Amazon ; 
Capt. Stanbury's exploralion of the Great Salt Lake; Captain 
Perry's Japan collections, etc., etc. This museum is stated to 
be now superior to any other in this country as a general collec- 
tion, though in the specialties of exotic birds, shells, fossils, and 
minprals, it is said to be surpassed by the Philadelphia Academy 
of Natural Sciences. We are glad to see that the Secretary who 
has charge of this department looks forward to the object of 
^^ havine a public museum, illustrating as fully as possible the 
natural history of the world, and taking rank with those of Lon- 
don, Paris, Berlin, and Vienna." — Washington Star. — Chicago 
Medical Examiner. 



Use of Cold Water (irrig'atirm) in restraining Inflammation 
and preventing Heat^ Pain and Redness in Fractures. 

The extremely satisfactory results that I have obtained in the 
Marine Hospital during the past winter by the continued applica- 
tion of cold water to the fractured limbs, induces me to add my 
testimony to that of Drs. Smith, Pope, and other surgeons. It 
would be difficult to use terms too extravagant in describing the 
ease, comfort, and prevention of pain, which this method of treat- 
ment secures to the patients even afti^r double compound comminut- 
ed fractures have been sustained. During its employment the indi- 
vidual feels no pain ; he has no fever, and he dots not obviously 
lose flesh ; be does not suffer from constitutional disturbance of 



868 Use of Cold Water in Inflammation^ Sfc, 

any kind, nor is he conscious indeed that so serious an injury has 
bel alien him, save when his eye is directed towards the member 
under treatment. At the end of the fifteenth day after entrance, 
the patient's physical condition is just as good as on the day of 
his admission ; because the limb being bathed day and night in 
fresh supplies of cold water, there is no pain, redness or inflam- 
mation, consequently no swelling, suppuration or waiting dis- 
charge, involving constitutional disturbance, loss of rest, ema- 
ciation, night sweats or loss of appetite. These are the usual 
concomitants of every other mode of treatment of fractures 
where the soft parts were injured. 

The leg is placed in a box made of block tin, in which it fits 
loosely and which embraces it above the knee. This is stuffed 
with cloth or paper at suitable intervals to keep the leg fixed. 
These substances may be removed one by one and the member 
cleansed without disturbing its position. At the most dependent 
portion of the box there is a tube passing out so far that the wa- 
ter falling upon the limb may escape outside of the bed. A bit- 
of oilcloth might be used as a substitute when the box cannot be 
had. No straps or bandages are used. A jar containing water, 
with alum, (and ice if the weather is warm) is suspended above 
the limb by cords attached to the four posts of the bed. From 
the jar are depended several strips of cloth or candle wick, so di- 
rected that the water, by capillary attraction, constantly drops 
upon the entire surface of the wound. This irrigation is kept up 
night and day for from twelve to fifteen days, at which time it is 
advisable to discontinue it, as the action of the water becomes in- 
jurious by creating irritation of the skin. Even in the coldest 
weather in winter this may be kept up by covering the patient's feet 
with carded cotton, to preserve a sufficient amount of warmth. 
Otherwise the temperature of the foot becomes too much lowered. 

The above method has been employed in five cases of fracture 
of the tibia, with perfectly satisfactory results in every instance. 
In the management of wounds, recent contusions, etc., whether 
connected or not with injury to the bones, the use of cold water 
has been, in my experience, equally applicable and successful. 

Management of Chronic Ulcers. — To secure with perfect 
certainty the healing of chronic vkersy whether situated or not 
on parts unfavorable to their healing, I have adopted a modifica- 
tion of the above plan. 

It was suggestea by the case of a man of scrofulous diathesis 
under treatment in the Marine Hospital two years ago, whose 
whole person was marked with old cicatrices of frequent former 
ulcerations. He informed me that he had been treated in the 
Dreadnought Hospital, near London, where they are in the habit 
of managing such sores, by light bags made of cotton or thin 
cloth, somewhat resembling a miniature pillow, that will retain 



Use of Cold Water in Bftammatum^ Sfc. 869 

floidsy which are frequently soaked in hot water and kept applied 
to the ulcerated surfaces. The difference in the temperature of 
the water adapts this mode of treatment to this peculiar form of 
disease by the special influence of hot application in lessening 
morbid aensibiiitjf. In healing ulcers, I have frequently directed 
that the bags should be immersed in cold water, first stimulating 
the ulcerated surface to great activity by the previous application 
of strong nitric acid — or nitric acid in which bits of copper have 
been dissolved. The escharotic is used every two or three days, 
the bags soaked in hot or cold water being applied continuously. 
Rest is enjoined and tonics and haemetics made use of. 

Fifteen oases were treated in the Hospital within the past fif-- 
teen months, and in every instance the patient has been discharged 
cured. After trying within the past three years every species of 
salve, local astringents, caustics, etc., in the attempt to come to 
some conclusion as to the relative value of each, and having been 
taught in earlier life to regard chronic ulcers as the opprobia of 
medicine, I now feel entirely confident that a case can hardly be 
so bad that it cannot be healed successfully after the method rec- 
ommended. Granting the fpecial value of hot applications in 
lessening morbid sensibility in parts extremely liable to it, I have 
yet thought that cold possesses these special advantages, also, in 
constringing the capillaries which have been relaxed by injury to 
the nerves governing their due contraction — as shown by the sur- 
rounding heat and redness ; therefore, some judgment may be ex- 
ercised in selecting the one or the other. 

J. H. Bennet says (Clinical Lectures, p. 168, General Treat- 
ment of Exudation:) ^' A correct treatment, therefore, will be 
influenced by the stage and nature of the exudation. To prevent 
or diminish the extent of an exudation, we must adopt measures 
to overcome the dilatation of the capillaries, their distension with 
blood, and the attractive power, (whatever it is,) which draws the 
liquor sanguinis into the surrounding textures. This is accom- 
plished — 1st, by local application of cold and astringents, which 
stimulate the capillaries to contraction ; 2d, by soothing topical 
applications, such as warm fomentations, opiates, etc., which re- 
lieve the irritation of the nerves in the part." * * 

" Thus locally, co/rf, dryness, and pressure, check ; while Aea/, 
moisture J and room for expansion, favor growth." 

ICharleston Med. Journal and Review. 
Vol. xk— 24 



870 On the Death of Dr. Fountain. 



Death of Dr. Fountain^ of Davenport y Iowa. 

Dr. Fountain's death occurred on Friday afternoon last, after 
great and continued sufTerin^ for a week, which he had borne with 
unflinching Chridtian fortitude. For some time past he had been 
continuing, at the suggestion of the American Medical Associa- 
tion, his researches upon the properties of chlorate of potassa as 
a remedy in phthisis, taking the ground that the article when pure 
was almost entirely harmless in large doses. Under this convic- 
tion, he took upon several occasions doses of half an ounce, and 
on Friday, at 10 o'clock A. M., he took one ounce, dissolved in a 
pint of water. No serious symptoms occurred through the day, 
except a profuse diuresis and discoloration of the superficial cir- 
culation, and he visited his patients as usual. Having eaten a 
hearty supper in the evening, he returned to his house, where he 
was shortly after seized with severe pain in the abdomen, and so 
greatly prostrated as to be unable for sometime to call assistance, 
(being alone in the house, his wife being absent at the East. ) He 
expected to die in this condition, but by a desperate effort suc- 
ceeded finally in calling his neighbors, who sent for his partner, 
Dr. Adler. His symptoms were after a time partially relieved, 
but soon he was seized with vomiting, ejecting a dark-colored, 
greenish fluid, being unable to retain any nourishment ; the secre* 
tion of the kidneys was also entirely suppressed. This condition 
continued, with a gradually increasing prostration of the system, 
(the mind being perfectly clear,) for seven days. 

^^The postmortem examination revealed extensive inflamma- 
tion and disorganization along the whole course of the intestinal 
canal, with adhesions agglutinating nearly the whole of the ab- 
dominal viscera; the gall bladder distended with a thick dark 
colored fluid ; the kidneys enlarged and lobulated externally ; the 
internal surface and substance engorged, and the uriniferous tubes 
distended, containing frequent points of a crystalline substance, 
which was, without doubt, chlorate of potass; and the bladder 
entirely empty, contracted and inflamed. 

As a full statement of the case will be published, it is unneces- 
sary for us to dwell further upon it. 

In the death of Dr. Fountain, the profession in the Northwest 
has lost one who was destined to prove one of its brightest orna- 
ments, and the community in which he lived, one of its most valua- 
ble citizens. — Chicago {jiprzl^ 1861) Tribune. 

Wo had little thought when penning the- above paragraph on 
**Chlorate of Potash," that our ideas were so soon to have a 
striking and melancholy illustration. This sad experiment has 
shown that although the article in question is comparatively inert, 
in doses ordinarily employed, yet in inordinate amount it is capa- 



On the Death qf Dr. Fauntain. 871 

bio of even fatal effects. In this respect it is altogether analo- 
gous to many other salines. We trast that this calamitous result 
may not fail to impress the needed lesson. 

It is to be hoped, that we shall hear no more of the intense 
folly of chlorate of potash being in any sense a remedy for phthi- 
sis. Phthisis never has been, and we hazard little in saying, 
never will be cured by medicine. If modern physiology and pa- 
thology have taught any one thing more than another, it is, tnat 
this fearful disease is to be met by nutrients and appropriate 
regimen. Medicine therein is only indirectly and remotely oene- 
ficial. And yet we have known case after case go down to death, 
in this very city of Chicago, during the winter just past, treated 
empirically with chlorate of potash, expectorants and seclusion. 
Why, it is not a year since one of our most estimable physicians 
allowed himself to be treated for phthisical symptoms with small 
doses of andmonials and low diet ! He fortunately escaped the 
immediate necessary effects, by seeking the natural tonic and 
stimulant effect of Lake Superior air and habits (including appro- 
priate drinks) during the last summer, and during the winter the 
opportunities of out- door air and exercise, and consequent invigor- 
ation of the digestive system, afforded by a Southern climate. 

It is our duty to make one other remark in this connection. 
Experiments made upon the healthy system are of doubtful im- 
port as illustrative of the effects upon the same system in a state 
of disease. The article which is rapidly eliminated by the healthy 
organ and thus proves harmless, may in a condition of disease 
prove deadly by its continuance in contact with the same. Ex- 
perience demonstrates the fact, however it \b explained. 

Much confusion exists in some minds as to the terms medicines, 
poisons and food. Medicines and poisons are agents capable of 
producing a change in the structure or action of any part or the 
whole of the system, although constituting no part ot the integral 
constituency. They are respectively poisons or medicines ac- 
cording as this change is not, or is, necessary. The degree of 
action does not constitute a scientific distinction in their nature. 
A medical action is never unnatural. It is a gross confusion of 
terms to call any medicine an unnatural agent. As well speak 
of the fire which restores the warmth of the body as an unnatural 
agent, because it can char and destroy the same body thrown into 
it. But food enters into the very structure of the body, and con- 
stitutes an integral part thereof. Not so entering or constituting, 
it is noxious, poisonous if you please, in kind if not in degree, 
as is woorara or arsenic. A like significance attends the idea of 
the influence of all the so-called imponderable agents. They are 
noxious or salutiferous according as the changes they tend to 
produce are not, or are, requisite. 

With due regard to strictness in the use of language, there is 



872 On the Death of Dr. Fountain. 

not, and cannot be, a specific for any disease, phthisis or other. 
In this day, it is as great a folly to search for it as for the 
"Philosopher's Stone," or the ** Elixir of Life'* of old time 
imaginings. 

Let the homoeopathists enjoy their specifics jointly with the other 
newspaper quacks, — we shall continue to steadfastly belieye that, 
though hand join in hand, they shall not escape their destined 
punishment. 

The yery best remedy for a diseased organ, whether a tuber- 
culous lung, an indolent ulcer, or a gouty toe, is to wash it with 
healthy blood, flowing from within outwardly, and not by healing 
salyes, inhalations, poultices, and specifics, working from without 
inwardly, as the manner of some is. 

The method of nature is to be imitated by art, but as Shaks- 
peare observantly writes, "The art itself is nature." It is all 
very well to train the branches and graft them, to wash and ner- 
adventure whitewash the trunk of your tree ; but if you wisn it 
to grow and flourish and bear goodly fruit, you must supply the 
rootlets and spongioles with nutrient fluids, and surround the 
leaves with appropriate atmosphere. 

One yery considerably eminent gentleman is reported to haye 
said that the great want of the present time is, a specific for tu- 
bercle, and a specific for cancer ; as in Scabies we nave sulphur, 
and in Syphilis, mercury, for specifics. The prayer of his heart 
can never be granted as he intended, although it may in fact. 
Because neither sulphur nor mercury are specifics within any cor- 
rect definition of the term. 

Specifics, whether chlorate of potash, or Morrison's pills, can 
have no existence anywhere, save in the imaginations of specula- 
tive theorists and hobby riders. 

In these remarks, we by no means would be thought to convey 
the idea, that the lamented Dr. Fountain was in any way commit- 
ted to the idea that chlorate of potash would prove specific in 
phthisis. We do not know whether he was or not ; but we do 
know that many who had read his articles on the subject, have 
already mounted this hobby and were fast riding it to the death — of 
their patients. For Heaven's sake, my Chlorate-of- Potash-bitten 
friend, don't ride this poor hobby to the nether regions as quickly 
as you did Veratrum Yiride, yesterday ; Aconite, the day before, 
and Digitalis a little while since. Or were you straddling the 
Hypophosphites last week ? We have medicines enough already — 
too many ; would that we knew better how to use them. 

Meanwhile, what do you say to a bit of beefsteak, tender, rare- 
done, washed down with generous beverages, (such as sayed the 
threatened life of our friend above spoken of, ) a little more pure 
air and sunlight, a clear conscience, sleep at night, and regular 
bowels ? These afford a remedy for phthisis worth thinking about. 

l^Chic^igo Med. Journal. 



MUUary Hygiene. 373 



Saniiary Condition of Troops, 

We pablish with pleasare the following excellent directions for 
the sanitary conduct of the troops in the field, which constitute 
the substance of a report prepared by Dr. John Ware, of the 
State Medical Commission, to be communicated to the Massa- 
chusetts regiments in active service. 

Directions. — Soldiers should recollect that in a campaign, 
where one dies in battle, from three to five die of disease, ion 
should be on your guard, therefore, more against this than the 
enemy, and you can do much for yourselves which nobody can do 
for you. 

1. Avoid, especially, all use of ardent spirits. If you will 
take them — take them rather after fatigue than before. But tea 
and 000*60 are much better. Those who use ardent spirits are 
always the first to be sick and the most likely to die. 

2. Avoid drinking freely of very cold water, especially when 
hot or fatigued, or directly after meals. Water quenches thirst 
better when not very cold and sipped in moderate quantities slow- 
ly — though less agreeable. At meals, tea, coffee, and chocolate 
are best. Between meals, the less the better. The safest in hot 
weather is molasses and water, with ginger, or small beer. 

8. Avoid all excesses and irregularities in eating and drinking. 
Eat sparingly of salt and smoked meats, and make it up by more 
vegetables, as squash, potatoes, peas, rice, hominy, Indian meal, 
&c., when yon can get them. Eat little between, when you have 
plenty at meals. 

4. Wear flannel all over in all weathers. Have it washed often 
when you can — when not, have it hung up in the sun. Take 
every opportunity to do the same by all your clothing, and keep 
everything about your person dry, especially when it is cold. 

5. Do not sit, and especially do not sleep upon the ground, 
even in hot weather. Spread your blanket upon hay, straw, 
shavings, brush-wood, or anything of the kind. If you sleep in 
the day, have some extra covering over: you. 

6. Sleep as much as yon can and whenever you can. It is 
better to sleep too warm than too cold. 

7. Recollect that cold and dampness are great breeders of dis- 
ease. Have a fire to sit around whenever you can, especially in 
the evening and after rain, and take care to dry every thing in 
and about your persons and tents. 

8. Take every opportunity of washing the whole body with 
soap and water. Rub well afterwards. If you bathe, remain in 
the water but a little while. 

9. If disease begins to prevail, wear a wide bandage of flannel 
around the bowels. 



8T4 Chlorate of Potash.— Chloroform in Chills. 

10. Keep in the open air, but not directly exposed to a hot 
sun. When obliged to do this, a thin, light, white covering over 
the head and neck, in the form of a cap with a cape, is a good pro- 
tection. 

11. Wear shoes with very thick soles, and keep them dry. 
When on the march* rubbing the feet, after washing, with oil, 
fat or tallow, protects against foot sores. — Boston Med. Jour. 



Chlorate of Potash. — This article has very nearly upset all 
the old hobbies. One of our friends uses it even when the patient 
is moribund ^Ho oxygenate the blood." Another, as a substi- 
tute for calomel as '^an anaplastic.'' Another, as a '^recondite 
alterative." Another, as ''a stimulant to the mucous mem- 
branes." Another, as * 'a refrigerant saline." Another, as an 
^^expectorant of specific characteristics." Another has found it 
an ''arterial sedative;" and another cures consumption and per- 
haps corns with it. Crystalized Elixir of Life! 

Seriously, we apprehend that the inordinate and indiscriminate 
use of this article is becoming a little too dangerous to continue 
merely ludicrous. It would seem to possess about as active prop- 
erties as the nitrate, but tending to elimination rather by the mu- 
cous membranes than by the kidneys. Aside from slight stimu- 
lant eflfects upon this membrane, we feel warranted in saying that 
there is no real evidence of its medicinal efficiency. It seems 
especially useful in certain morbid conditions of the respiratory 
mucous membrane. Employed, as it frequently is, in aqueous 
solution acidulated by hyarochloric acid, it of course has to divide 
the honor of success with the acid of the menstruum. We really 
hope that this very clever little medicine may not be **run into 
the ground" by its present enthusiastic admirers. We have too 
much regard for it, in some cases and in small doses, as a very 
convenient placebo — cheaper even than iodide potassium. — Chi- 
cago Med. Jour. 



Chloroform in Congestive Chills. — ^In the Oglethorpe Medical 
and Surgical Journal for July, Prof. H. L. Byrd has an article 
upon the treatment of congestive chills with chloroform by inha- 
lation. On a former occasion, we called attention to an article 
upon the same subject, by Dr. Keator of Louisiana. The last 
named gentleman introduced the chloroform into the stomach, 
while Prof. Bjrd gives it by inhalation. He says, "My impres- 
sion is, that chloroform inhaled during the cold stage of fever, 
or in a ^congestive chill,' to the extent of making a decided im- 



Laryngoscope. 875 

pression upon the system, is perhaps the most valuable remedy 
known to the profession.'^ 

He says, further, ** With chloroform and quinic ether at hand, 
I predict that the heretofore fatal ^congestive chills,' which have 
been regarded with so much terror by the physicians of South- 
western States, will be as easily managed as any of the milder 
grades of miasmatic fever." 



Laryngoscope. — ^Listen recommended, in his ''Practical Sur- 
gery," for examination of the larynx, a '' specalum on a long 
stalk, previously dipped in hot water, introduced with its reflecting 
surface downward, and carried wet into the fauces." This hint, 
however, remained unnoticed till 1855, when Garcia made his 
autolaryngoscopic investigations by means of a mirror placed 
against the soft palate, receiving the reflected image of the larynx 
upon a second mirror placed in front of the observer. This laryn- 
goscope was soon abandoned again. Since 1857, some practi- 
tioners in Qermany, more particularly Dr. Turck, in Vienna, and 
Prof. Ezermack, in Presth, have devoted their attention to this 
subject, and finally contrived an apparatus capable not only of 
assisting in the diagnosis, but of serving to guide the hand and 
otherwise assist in the treatment of disease of these parts. 

Prof. Ezermack's laryngoscope consists of a small metallic 
minor, varying in size from six to fourteen lines in diameter, 
square, with rounded edges (oval according to Turck's proposal ; 
found by Dr. Levin of Berlin more convenient when semicircular, 
with a concave inferior margin), soldered to a slightly- flexible 
metallic handle. To prevent the mirror from becoming dim by 
condensation of vapor upon its surface, it is necessary to warm 
it, previous to introduction, by dipping it it in hot water, or hold- 
ing the unpolished surface over the flame of a small spirit lamp. 
Ezermack does not, like Garcia, depend upon the light of the sun, 
but has adopted the method of artificial illumination employed by 
Prof. Helmhoth in ophthalmoscopic operations, using a perfora- 
ted concave reflector, or illuminating mirror, bv which tne light 
of an ordinary lamp can be concentrated upon the larynx* specu- 
lum. This second mirror is fixed either round the head of the 
surgeon, or attached to a large spectacle frame, or held between 
the teeth of the observer, by means of a suitable ivory handle, or 
suspended from a support screwed to the corner of the table on 
which the lamp is placed. As the distinctness of the image de- 
pends upon the brilliancy of the illumination employed, it will be 
found advantageous to concentrate the light of the lamp upon the 
concave mirror by means of a powerful bi- convex lens. Dr. 
Levin has devised a highly convenient apparatus for this purpose, 



876 Pus Corpuscks in the Air. 

consisting of a tin tube carrying a conyex lens of two and a half 
inches focal distance, and about the same diameter, which can be 
fixed horizontally over an Argand lamp. 

The patient is seated in front of the operator, with his hands 
resting on the knees, the body inclined forward, the head thrown 
back, the mouth wide open, and the toneue as much depressed 
and flattened as possible. The lamp is best placed to the right 
of, or a little behind the patient. The operator supports the head 
and chin with his left, and introduces the speculum with his right 
hand, while the patient is ordered to take a deep inspiration and 
emit the sound of a alternately. By this the velum and uvula are 
raised so as to permit the introduction of the mirror with greater 
facility, which is then directed to suit the position of the part to 
be inspected. 

Laryngoscopy, thus performed by a dexterous and experienced 
hand — because it requires much experience to acquire facility in 
its practice — enables not only the deeper portions of the larynx 
to be examined, but even the bifurcation of the bronchi may be 
distinguished through the widely -opened glottis. On the whole, 
however, examinations of this kind are naturally surrounded by 
numerous diflSulties, and can only be expected to succeed under a 
combination of favorable circumstances. — Edinb. Med. Journal. 
— Cincinnati Lancet <• Observer. 



Pus Corpuscles in the Air ! — •^n •BSroscopic Study by Docent 
Dr. Theoph. Eiselt in Prag. 

[Translated for the Boston Medfcal and Sar^lcal Joamal, from the Wochenblatt 

der Zeitachrift der k. k. OeseUschaft der Aerzte in Wien, March 26, 

1861, by J. C. White, M.D.] 

During an epidemic of conjunctival blnenorrhoea, which prevail- 
ed a short time ago in the Orphan Asylum at Bepy, eight miles 
distant from Prague, I had opportunity to learn by experience 
that infection may take place in other ways than by contact. 
Reserving for future description the particulars of this interesting 
epidemic, it will be sufficient for my present purpose to show its 
intensity by a few numerical data. Such foundlings as are given 
up by their foster-parents are brought to the larse and newly-built 
institution at Bepy. Among these two hundred and fifty found- 
lings, of whom the majority arc between the ages of six and ten, 
there occurred in I860, from Nov'ember to December, forty- six, 
and in the period between the 16th and 2l3t of February, 18G1, 
also forty-six cases of acute conjunctival blennorrhoea. His Ex- 
cellency, the Governor of Bohemia, Count Forgach, presided per- 
sonally on the 19th of February at a Council in Bepy, at which 
Prof. Bitter von Hasner, Landes-medizinalrath- substitute Dr. 



Pub Corpuacles in the Jlir. 877 

Hoser, Dr. Biermann, Director of the Hospital, and myself, as 
boose physician, were present, and ordered the perfectly healthy 
children to be left at Repy, but the diseased and infected to be 
removed with the greatest haste from the institution. Forty- six 
children were found unaffected, while the newly attacked and those 
which exhibited merely an injection of the conjunctiva or papil- 
lary structure of the membrane without suppuration, were brought 
to Prague, and distributed in eight diflerent localities. In the 
latter place, four-fifths, and in Repy all of the children, were un- 
der my care. 

It will readily be believed that as a physician I took the great- 
est precautions to protect myself against infection. I was particu- 
larly careful not to touch my own eyes. The cleansing of those 
of the patients was entrusted to the Sisters of Charity, and most 
punctiliously performed. No chance of contagion from this 
source was possible, therefore, nor did any scattering of pus take 
place either by the patients sneezing or coughing during their ex- 
amination. 1 was in the habit of going to the Asylum at Repy 
daily, where I first examined the healthy inmates, then touched 
the lighter cases of the disease with cuprum, and visited the 
worst last of all. Whenever I had in this way spent a few hours 
in the wards, I was sure to feel a sensation of burning and press- 
ure in the eyes, without being able to observe anything upon the 
conjunctivas except streaks of injection on the edges of the lids. 
In the course of a few hours this unpleasant feeling disappeared 
of itself. When the patients were brought to Prague and I visit- 
ed them daily, this sensation of pain remained constant, the car- 
buncles became red as well as the whole conjunctiva palpebrarum, 
and the semilunar fold became livid and so o&dematous that the 
movements of the globe were impaired, accompanied by a mucous 
secretion, so that the lids adhered in the morning. In other 
words, I was infected without having become so by contact. The 
same happened without exception to all the nurses. Of seven of 
the nuns severely affected, two had caught the disease by the 
spattering back of the water while cleaning the eyes, two from 
the dissemination of pus by the sneezing and coughing of the chil- 
dren during the same process, one by washing the bandages, and 
two in some inexplicable manner. The infection in my own case 
only needed more unfavorable circumstances to become converted 
into an acute affection ; as it was, however, application of weak 
solutions of nitrate of silver caused it to diminish in intensity. 

Here, then, we have the fact that a person may be attacked by 
an acute conjunctival blennorrhoea without purulent contact in the 
ordinary sense ; there is wanting only the explanation — how is 
this possible ? 

Ponchet, who for many years has been engaged in the micro- 
scopic analysis of the air, describes, in the CompL Rendus for 



878 Pus Corpuscles in the Air. 

April, 1860, an apparatus which he calls an aeroscope. Through 
the kindness of our respected Prof. Purkjne a similar contrivance 
was prepared here. It depends upon the plan of driving a cer- 
tain quantity of air across a glass plate moistened with glycerine, 
upon which the particles of dust and microscopic forms remain 
fixed, and may be thus readily examined by the microscope. The 
apparatus consists of a hydrostatic aspirator and two glass tubes, 
of which the first terminates at its upper extremity in a small 
funnel, the infundibuliform opening being directed upwards, while 
the lower is drawn out into a point of 0.50 of a millimetre in 
diameter. The second tube is ground into the first, and its upper 
opening is covered with a fine metallic sieve, upon which the glass 
plate is fastened. This plate is brought to within one millime- 
tre's distance from the lower funnel-shaped opening by pushing 
in the tube, and the lower end of tube No. 2 is hermetrically 
united to the aspirator, which is filled with water. The latter is 
merely a vessel made of zinc plate, two feet high and one foot 
square at its base, having at the bottom a stop-cock, and in the 
cover a mouthpiece for connection with the glass tube. If now 
the water be allowed to flow from the aspirator through the stop- 
cock, the same bulk of air will stream in through the funnel, and 
the matter suspended in it will remain sticking to the glass plate. 

This aeroscope, as modified by Prof. Purkyne, was placed be- 
tween the beds of two patients in a ward in which were thirty- 
three boys with acute conjunctival blennorrhcea accompanied by 
great secretion of pus, and the air was drawn through it. It 
must, moreover, be stated that the eyes were washed by means of 
glass syringes with warm water, and that from this room alone 
several pails of waste water were thrown away daily, presenting a 
milky appearance from the pus it contained. The experiment 
was made at 10 A. M., after the apartment had been ventilated, 
and pus corpuscles were delected in the almosphere by the 
vert/ first transmission through the apparatus. 

In this fact lies the explanation of the attacks above described, 
in which cases direct contact with the patients and the blennor- 
rhagic secretion was excluded. Infection took place by means 
of pus corpuscles suspended in the atmosphere. 

In presenting this short but significant communication of our 
respected colleague and friend to the knowledge of our readers, 
we cannot forbear adding a few words, prompted by the impor- 
tance of the subject, and with the more reason, that Dr. Eiselt has 
far too modestly disdained to surround the announcement of his 
discovery with that display, which, in science as well as in other 
fields of human knowledge, appears necessary to procure for a 
new fact its merited consideration and recognition. 

The great significance of this discovery to pathology in gen- 



Editorial. 87£ 

eraly and to the study of contagion in particular, and the immense 
importance of this fact, ivhen more thoronghly studied and cor- 
roborated, in connection with the care of the sick and the erection 
of hospitals, need not be farther impressed upon the physician. A 
new sphere of objective information is thus promisingly revealed, 
a new and hitherto all untrodden path opened, which, whether its 
results be negative or positive, will at all events lead to the ad- 
vancement of science. **♦**♦♦ 

We are able to say that in consideration of the high importance 
of this subject, many members of our society have united to give 
a thorough investigation, and we shall not fail to keep our readers 
constantly acquainted with the progress of these examinations, 
which from the abundance of suitable material afforded by Vienna, 
and from the combination and systematic employment of so many 
forces, promise a speedy and conclusive result. — Editors of the 
Wochenblatt, — Boston Med. 6r Surg. Jour. 



PART IV. 

EDITORIAL. 

MILITARY SURGERY. 



Under the head of Bibliographs, we have already briefly noticed 
one of the small works on Military Surgery, recently called forth 
by the extraordinary and melancholy exigencies of the times. 
Since then, we have received two other works of a like character, 
'but too late to claim a notice under the appropriate head. 

One of these is by Professor S. D. Gross of Philadelphia. It 
18 so small as to be conveniently carried in the pocket, but at the 
same time contains much important information, which young 
physicians who have so hurriedly entered the volunteer service, 
perhaps not always with a full knowledge of the weighty respon- 
sibilities of their position, would do well to possess themselves 
of. The other is rather a more elaborate treatise — still, not by 
any means voluminous — ^by Professor Frank H. Hamilton of New 
York, the object of which is to supply information upon those 
points in sugery, medicine and hygiene, which, as having relation 
especially to military and naval practice, are usually not consid- 
ered in general treatises. It is an invaluable work to the camp 
physician and surgeon. The acknowledged ability of these two 
authors will at once give authority to their respective works, which 
we fear there will be but too much necessity to consult in hospi- 
tal, in camp, and on the field. 



380 Ediiorial. 

APOLOGETIC. 

We hardly deem it necessary to apologize for the small amount 
of editorial and miscellaneous matter in the present number of our 
journal. The fact is our mind has been so occupied with the dis- 
tressed condition of our bleeding country, that we have not felt 
the least disposition to read or write on medical subjects, or even 
to look over our exchanges. 



RESIDENT PHYSICIAN TO THE ST. LOUIS CITY HOSPITAL. 

Dr. L. T. Pimm of this city has been appointed by the Mayor 
Resident Physician to the St. Louis City Hospital, and he has al- 
ready entered upon the discharge of the arduous duties of his office. 
This is a good appointment, and we feel satisfied that neither the 
interest of the patient nor the cause of science will be allowed to 
suffer in Dr. Pimm's hands. 



THE ISSUE OF SMALL NOTES. 

Under a special act of the Legislature, our banks are on the 
eve of issuing notes of a smaller denomination than five dollars, 
in order to meet the exigency of the times. This will afford a 
good opportunity to such of our subscribers in this State and 
elsewhere as are in arrears (and unfortunately there are many 
such) of remitting by mail. We sincerely hope that they will 
avail themselves of the facility thus afforded. Our printers have 
to be paid these hard times, (for without it they cannot live,) 
whether our subscribers comply with their engagements or not. 
Let us hear from you, therefore, gentlemen Doctors, at your ear- 
liest convenience. 



MEDICAL MISCELLANY. 

Deferred Communications. — We are in receipt of communi- 
cations from Drs. Curtis and Vasse, which will appear in our next 
number, having come to hand too late for the present issue. We 
are at all times glad to hear from our friends in this way. 



Medical Miscellany* 881 

Homoeopathy in the Michigan University. — ^We are glad to 
learn from a letter of Prof. Palmer to the Chicago Medical Ex- 
aminer, that the Legislature of Michigan did not pass a law re- 
quiring the establishment of a chair of Homoeopathy in the Medi- 
cal Department of the State University of Michigan, A bill to 
that effect was introduced by a quack doctor, but it failed to pass. 
We are glad to learn this. Having on the authority of others 
made the statement, we now cheerfully make the correction. 

Jlrmy Medical Board. — The Boston Journal says : " It is 
stated that the Secretary of War has instructed Surgeon- General 
Finley to convene an Army Medical Board at Washington, for 
the purpose of examining candidates for Brigadier Surgeons, and 
report, and the appointment shall be made only from among those 
who are reported as qualified. In consequence of numerous com- 
plaints having been made to the Department of the incompetency 
of regimental surgeons who have been appointed either by the 
commanding officer or the Governors of States, a similar Board 
has been instituted. The Board will examine the surgeons of 
whom complaint has been made, in order to secure their dismissal 
if found incompetent." 

Summary of Medical Science* — ^We have received the first 
number of this semi-annual summary and digest of practical 
medicine and surgery, gathered from the leading American and 
Foreign Journals, and edited by Walter S. Wells, M.D., compiler 
of Braithwate's Retrospect and Rankin's Abstract. It is to be 
issued semi-annually by Chas. T. Evans, No. 532 Broadway, N. 
Y. The scope of the volume can readily be understood by the 
works in which the author has heretofore been engaged. It is 
well gotten up, contains a large amount of useful matter, con- 
veniently arranged, and should be in the hands of every physi- 
cian. 

Death of a Medical Editor. — ^David Meridith Reese, M.D., 
LL.D., late editor of the American Medical Gazette, died in 
New York on the 18th of May, of disease of the heart. Dr. 
Reese was well known to the profession of this country as a bold 
and vigorous writer. He was a native of Maryland, a graduate 
of the Maryland Medical University, and at the time of his death 
was 61 years of age. 

To Prevent Vomiting from Chloroform. — According to Dr. 
Fischer, a glass of wine taken 15-80 minutes before chloroform, 
will entirely prevent the vomiting so often troublesome after in- 
halation. Perhaps, he adds, the dangers may also be lessened 
by this simple means. 



882 Medical MUcellany. 

The Application of the JVXtraie of Silver by Inhalation. — 
Dr. D. P. Tetter, in the Amer. Med. Times says : " For a num- 
ber of years I have been applying the nitrate of silver, well trita- 
rated with a little white sugar, directly to the larynx and trachea, 
by the means of a small glass tube, three or four inches" long. 
The powder is placed in the tube, the forefinger is then placed on 
one end, the other is passed into the mouth as far as possible 
without coming in contact with the epiglottis ; the mouth is then 
closed tightly over the tube, the finger is then removed, and at 
the same moment a strong inhalation or inspiration will draw the 
powder into the larynx and trachea, where it is absorbed by the 
mucous membrane, without any unpleasant sensations. By this 
means the unpleasantness of having the probang thrust into the 
larynx is avoided, and the benefits received are the same, but 
more satisfactory. After the first application, the patient can 
repeat the same without assistance." 

Bread-Making. — A new process for the manufacture of bread, 
by forcing carbonic acid into the water to be used in forming the 
dough, was introduced into the chemical section of the British 
Association at Aberdeen ; it is said to be used successfully in 
London. The use of yeast is superseded. 

Iodine in Ointments, — ^Iodine may be dissolved in a little 
chloroform and triturated with the lard ; the excess of chloroform 
readily evaporates, and the ointment contains the iodine uniformly 
mixed. 

fVhooping Cough. — ^The Journal of Materia Medica quotes 
the following from Dr. Benson, in the Louisville Journal, as a 
good formula in case of whooping cough. K — ^Acid hydrocyan. 

ftt. vi. ; ext. belladonna, grs. ii. ; tr. opii camph., 3 iii. ; syrup 
als. tolu., 3 i. ; aqua font, 3 iii — M. One teaspoonful four 
times a day, and also in the night paroxysms. 

Postponed for one year. — The committee at Chicago wisely 
determined to postpone the meeting of the American Medical 
Association, which was to have been held last month, for one year, 
on account of the civil war now unhappily raging. 

Our Southern Exchanges. ^^Ow'mg to the suspension of the 
mails to the seceded States, and non-intercourse between the two 
confederacies, we are without our usual Southern exchanges. We 
regard this as a real loss and regret it accordingly, but indulge 
the hope that it will only be temporarily, and that friendly inter- 
course will soon be established between the sections. 



Medical Miscellany. 388 

Digitals in large doses in Menorrhagia. — ^The D^nggist's 
Circular quotes the following from the Gazette des Hopitaox: 
<^ Mr. Trousseaa speaks favorably of the employment of digitalis 
in strong infusion in cases of severe menorrhsgia, to be given in 
tablespoonfttl doses every half hour. The strength of the infu- 
sion, when a severe attack is threatened, may even be as much as 
an ounce of the leaves to a quart of water, which is certainly an 
extreme dose, and requires great circumspection. Whenever the 
toxic eflfects of the drug, vomiting, diarrhoea, etc., make their ap- 
pearance, the further administration is to be discontinued." 

Medicine in Prussia. — The medical staff of Prussia, at a 
population of 17,739,913, amounts to 358 district physicians 
(paid by government, and have to attend the poor gratis), 4327 
physicians with degree of doctor, 996 surgeons of the first clasd, 
643 of the second class, 1020 veterinarians, 1529 chemists, and 
11,411 midwives. 

Arsenic tu Menorrhagia^ etc. — The Cincinnati Lancet quotes 
the following from the American Journal : *' The plan of Dr. A. 
P. Burns is, to give immediately from ten to twenty drops of 
Fowler's solution, repeated every fifteen or twenty minutes, until 
the haemorrhage is checked. From three to five drops of the 
same remedy are given, three times a day, for the cure of leucor- 
rhoea. In either affection, if there is debility, the solution is com- 
bined with three ounces of tinct. cinch, comp. and two drachms 
of tinct. canthar., a teaspoonful three times a day, occasionally 
with the addition of spirits seth. nitr. and tinct. opii camph. The 
arsenical solution is also stated to be a prompt and effective rem- 
edy against the haemorrhage, in treating abortion, or after de- 
livery." 

Lead Poisoning in the production of •Abortion. — The Bos- 
ton Med. & Surg. Journal says: ''The following figures have 
been published by M. Paul Dubois, in a statistical investigation 
of the subject of the influence of lead poisoning in the production 
of abortion. Out of 141 pregnancies in females under the influ- 
ence of lead, 82 abortions took place ; in 4, premature confine- 
ments occurred; in 6, the children were stillborn; in 20, the 
children died in the course of the first year; in 8, during the sec- 
ond year ; and in 7, in the third, &c." 

Successor to Professor Meigs. — Dr. William V. Keating of 
Philadelphia has been appointed Professor of Obstetrics in the 
Jefferson Medical College, in the place of Dr. Charles D. Meigs, 
resigned. 



( 



884 Medical Miscellany. 

Poisoning from Painted Candy. — The Chicago Medical 
Journal says : Two cases, in one family, have recently come un- 
der our observation of quite flcvere symptoms of irritant metallie 
poisoning, from eating the richly colored candies offered for sale 
in the shops. The yellow colored candy (probably from the 
presence of orpiment^ appears to have been the active agent. 
Cannot measures be taken to prevent this dangerous practice 7 It 
is well known that children are liable to similar attacks from suck- 
ing off the paint from their colored toys. 

Treatment of the Freckles of Pregnancy. — The Pacific 
Med. & Surg. Jour, quotes the following from the Bui. Therap. : 
*^ When freckles, which are of such common occurrence in preg- 
nancy, persist after delivery, M. Hardy recommends the follow- 
ing lotion : Dist. water 125 parts, corrosive sublimate ^ part, sp. 
wine 9 parts, to dissolve it, sulph. zinc, acetate of lead, aa 2 
parts. When this application fails. Bareges or Luchon water, 
applied as local douches to the parts affected, induce slight inflam- 
mation, which facilitates the absorption of the pigmentary de- 
posits.*' 

Summary of Medical Science.' — Dr. Walter S. Wells of New 
York, who has so successfully presented an epitome of Braith- 
waite's Retrospect, proposes to bring out semi-annually a sum- 
mary of medical sciences, containing all the choice articles on the 
various retrospects and abstracts, together with the English, 
French, German, and other journals. It will, doubtless, be a 
most acceptable work. For particulars, see advertisement under 
the appropriate head. 



Death from the Diphtheritic Virus. — The American Medical 
Times says: *' Another instance of the death of a physician by 
the communication of the diphtheritic virus from the patient is 
reported. The French journals state that Dr. Gendron of Tours, 
while attending a woman suffering from croup, had his face cov- 
ered with the expectorated matter, while the patient was under- 
going the operation of tracheotomy. He was very fearful of this 
attack which promptly occurred, and of which he died. It will be 
remembered that the lamented Dr. Charles Frick of Baltimore, 
lost his life in a similar manner, being attacked with diphtheria 
soon after performing tracheotomy on a patient dying of that 
disease." 

Surgeon General of the U. S. — Clement A. Finley, M.D., 
has been appointed Surgeon General of the U. S. Army, in the 
place of Dr. Lawson, deceased. 



THE ST. LOUIS 

MEDICAL MD SURGICAL JOURNAL. 

Vol. XIX. SEPTEMBER, 1861. No. 5. 

PART I.— ORIGINAL COMMUNICATIONS. 

ARTICLE I. 

A Memoir on Facial JSTeurdlgia^ illustrated by a case affect' 
ing the Sub- orbital J^erve* Cured by Excision — with 
Observations thereon. SyDr. Costanzo Mazzoni qfBome^ 
Italy. 

[ Continued from page 505. ] 

In the female operated on by Berard, the pain extended only 
along the sub-orbital branches, as we see from Valleix : H y a dix- 
hait on vingt ans qae sans caase connue, ni coup, ni chute sur 
la joue, sans douleurs ant6cedentes des dents, de la mftchoire 
superieure, elle f ut prise d' 6lancement dans le trajet du nerf 
sous-orbitaire gauche ♦♦♦♦♦♦♦ 

les douleurs se repandent dans toute la joue : contractions, con- 
Yulsions des muscles de la face.* The pain in the case of which 
we treat was invariably limited to the sub-orbital branches alone ; 
in this, as in the above, the successful issue (the speedy cure) jus- 

^ Valleix, Trait, des N^vralg. N^vralgie trifaciale— douzi^me observation. 
N^vralgie du nerf sous-orbitaire — resection du nerf— gueriaon. 

Vol. XIX— 25 



386 Memoir on Facial JV^eura/gia. 

tified the complete indication of the recision. Nor does this sin- 
gle observation suffice as regards the seat of the complaint in 
question : there is also another of purely medical import and not 
less worth; of study than the former. The various neuralgias 
are sometimes found in conjunction with certain general motbid 
conditions; as, for example, with iste hypo -chlorosis, etc., in 
which cases it would therefore be madness to excise any of the 
nervous branches affected, as the malady, although it may ap- 
pear only on certain ramifications, extends through the whole 
nervous system. In such instances, the neuralgias are found 
frequently to agonize various nervous branches simultaneously ; 
prosopalgy, for example, will occur in the right side, intercostal 
neuralgia in the left. They are besides, in the majority of cases, 
but short-lived, and the pain often deserts one branch to settle 
on another; we thus sometimes see that the cervico- occipital 
neuralgia is followed by the cervico-brachial. The general state, 
however, of the patient, the syndrome proper to chlorosis, * * * 
the instability and brief duration of the neuralgias, are all 
so many circumstances that should direct the practitioner to 
remedial sources of quite another kind, proved by experience to 
be capable of curing these neuralgias, which well deserve the 
designation of symptomatic. 

But a most powerful cause of ill success and relapses even in 
cases wherein one may have had in view the resection of the sub- 
orbital nerve, is to be ascribed to the incomplete excision of the 
nerve itself. We invite our readers to pay diligent attention to 
the course of the palpebro- nasal nerve ; let them principally di- 
rect their attention to the secondary ramification which girds the 
sub-orbital cavity; let them remark its depth, its divergence 
from the other branches, beginning from the egress of the sub- 
orbital foramen. There are some surgeons who have fancied 
that in the resection they came to a knowledge of all the ramifi- 
cations of the sub-orbital nerve, by isolating with a * * * 
all the filaments that emerge from this cavity. It is no easy 
task, however, nay, I would say, that it is impossible to isolate 
in this manner even the palpebro-nasal nerve, as it grazes the 
bone and separates even in the interior of the canal from all 
other branches ; it is difficult, nay, I would say impossible, with 
a stroke of the bistoury or scissors to excise together with all the 



Memoir on Facial JYeura/gia. 887 

other branches of the palpebro- nasal nerve; while, if one suc- 
ceeded in cutting the ascending branch of the palpebro- nasal 
nerve, the descending or reflex, which originates from it precisely 
where it emerges from the sub- orbital cavity, would still remain 
intact. To remove, therefore, a porcion of the palpcbro-nasal 
nerve requires a minute knowledge of it beforehand ; it is requi- 
site to search it out patiently at its origin, in order to incise with 
safety the reflex branch also. The greatest length of time was 
employed in making an accurate search after this very branch : 
it was only then that the neuralgic pain instantly ceased ; while 
it continued although all other branches of the sub- orbital nerve 
were cut. After this every one will understand the reason and 
manner of the reappearance of the neuralgic access immediately 
or shortly after the operation, even when the resection of the 
sub- orbital nerve may have been effected. The anastomosis of 
the ascending branch of the palpebro -nasal nerve with the inter- 
nal frontal and with the sub-trocleator, the union of the reflex 
branch with the superior labial branches now clearly explain to 
us the persistency or return of the pain in the sub orbital cavity, 
in the upper lip, on the bridge of the nose, on the eyebrow and 
forehead, in all those unfortunate cases in which we have com- 
pletely cut the sub- orbital nerve. This is the true reason why 
the resections performed several times have rarely succeeded, 
that is, then only when by some happy chance the palpebro-nasal 
nerve escaped intact. And this is another reason why sev- 
eral surgeons should join to the resection a deep cauterization, 
which, applied almost instinctively — that is, without understanding 
the real motive of it — would have been useless and dispensed with 
if previously the operator had had a just knowledge of the nerve 
we have so often mentioned. For which reason, no one will ac- 
cuse me of venturing a hasty judgment in attribating to the ac- 
cidental * * * of the palpebro- nasal nerve, the two for- 
tunate issues obtained by Berard by means of the excision of the 
sub-orbital nerve ; which he himself was constrained, for his want 
of success in the other cases, to add cauterization to the bistoury 
in order to assure success ; for by means of cauterization, as 
Boyer excellently observes, we not only destroy at a given point 
or part the whole bulk of the nerve, bat attack all the nervous 
fillets which to a considerable extent are derived therefrom ; and 



888 Memoir on Facial Neuralgia. 

which, being capable of participating of the complaint in the said 
nerye, woald, like the principal branch, be susceptible of retaining 
the pain after the recision. And thus it is that this beautiful 
discovery of Mazzoni's has cast a new light on surgisal pathology. 
Having pointed out the primary sources of failure, let us now 
proceed to other considerations. 

Among the various classifications of trifacial neuralgia, we 
think the most important is that by Ghaussier, who classifies the 
neuralgia according to most of the interesting branches of the 
* * * * although from its precision and admira- 
ble propriety it has been adopted by the greater part of authors 
who have written subsequent to Ghaussier ; nevertheless, in more 
recent times, several writers, and especially Berard, have re- 
marked, that Ghaussier's classification scarcely ever tallies per- 
fectly with the results of observation ; and where he describes a 
frontal, sub-orbital or an inferior dentary neuralgia, it was neces- 
sary to understand that the nerves of this name were principally 
and not exclusively afiected. '* Such an intimate bond," reason 
they, ** exists between the three branches of the * * * * 
nerve, even after their emerging from the cranium as far as the 
last termination, that it is difficult to imagine how they can be 
afiected separately. Springing From common roots, they have af- 
terwards, it is true, a special destination, but their numerous 
points of contact in almost every part of the head scarcely ad- 
mits of their being distinguished as particular nerves. In this 
manner, each of these branches is in communication with the other 
two." Valleix agrees almost completely in opinion with Berard, 
as we may perceive from the following passage : ** Lorsqu' on 
d^signe la n^vralgie trifaciale sous le nom de n6vralgie frontal 
sous-orbitaire, etc., il faut entendre, ainsi que I'ont fait re- 
marquer plusieurs auteurs r6cents, une nevralgie qui a son prin- 
cipal 8i6ge dans un de ces rameaux, mais qui s' 6tend le pins 
souvent a d'autres," (p. 81.) I said almost compltttly ; for 
if, considering the incontestable observations made in regard to 
neuralgias confined to a sole branch, and especially to the infe- 
rior mascellar, he would seem at first sight to incline towards the 
division of Ghaussier, at least as regards the third branch ; never- 
theless, as the number of neuralgias limited to a sole branch is 
exceedingly small compared with those that propagate themselves 



Memoir on Facial JViuralgia. 889 

to several branches, whether it be that in the generality of cases 
of frontal neuralgia the patient occasionally experiences vague 
pains which cannot be determined, and becanse, in fine, in the 
majority of instances of inferior dentary neuralgia, (wherein he 
himself confesses that the pain often seems really restricted,) 
while this exists in a considerably violent degree, the branches of 
the ophthalmic and superior mascellar nerve are likewise affected 
with a very aching pain ; swayed by these considerations he steers 
a better course, and one that better corresponds with skilled prac- 
tice, by regarding the facial neuralgia as one and the same affec- 
tion, no matter in what part of the * * * * nerve it may 
have its seat. 

As for the rest, however this may be, the simple neuralgia of 
the upper mascellar nerve is regarded by Yalleix and other writers, 
not only as difficult and exceedingly doubtful, but instances of 
the pain appearing originally in the said branch are of very rare 
occurrence; so that he enumerates only two kinds of particular 
neuralgias ; namely, the frontal and the inferior dentary, regard- 
ing them as mere unmeaning varieties. ^^ Quant aux esp^ces 
particulidres, les n^uralgies dentaire inferieure et frontale sont les 
seules qu'on pourrait reconnattre, en ne les regardant toute fois 
que comme de simples vari6t6s qui ne meritent pas une descrip* 
tion speciale.'^ It is a fact proved by daily experience, that in 
the majority of cases of trifacial neuralgia the pain extends to 
various branches ; however, to regard the confinement of the pain 
to any of the three branches as a rarity or exception is not in 
conformity with the results of experience; and the proposition 
of Antonio Scarpa is still more untenable when subjected to the 
analysis of facts ; for this writer absolutely denies the possibility 
of the neuralgia being confined to one of the three branches, in- 
asmuch as according to his mistaken idea from the point of ap- 
pearance and from the extension of the pain, we should fix the 
origin and extension of the neuralgia ; the neuralgia may attack 
the whole extent of a given nerve, from its first origin, from the 
greater centre even to its remotest peripheric ramifications^ and 
the pain appear only in the points of its superficial and cutaneous 
course where precisely it is more susceptible to the exciting influ- 
ences of external agency. 

And as for the opinion of Yalleix, it is first of all opposed to 



390 Memoir on Facial JViurafgia. 

analogy and induction drawn from facts associated with other 
branches of the nervoas apparatus. 

Wherever nerves exist, their ramifications and terminal peripheric 
extremities cross and interlace each other so as to constitute a 
most admirable net, which of itself, even if all the other systems 
composing the viscera, organs and tissues, would suffice to pre- 
serve the form of human organism. This union (this interweav- 
ing) impressed the ancient anatomists with the belief that the 
nervous substance was cast in the anastomoses, and that one ner- 
vous extremity * • * in the other after the manner of pot- 
tery — a theory demonstrated to be erroneous by Miieller, Valen- 
tine, Milne, Edwards, and Charles Robin. It was from the re- 
searches of these distinguished micographs and physiologists, that 
each nerve was considered as a distinct tube or filament from its 
first origin to its termination ; which * * * can apply to other 
nerves even of different natures and functions without their sub- 
stances being fused, while a real fusion occurs in the neurilemi. 
Just in the same way as we often perceive some nerve which is- 
suing from its fascio proceeds by means of the neurilematic anas- 
tomosis to accompany the nerves of other fascia endowed with a 
different nature, it may likewise be understood how the morbid 
condition, whatever it may be, constituting the neuralgic affec- 
tion developed in any fascia, may isolate itself in its own ramifi- 
cations, although they may connect themselves with others of the 
adjoining nerves. From all this, and moreover considering the 
true mechanism of the nerves in the formation of the plexus, I 
am disinclined to believe that the numerous points of contact 
peculiar to the nerves in different places, and especially in the 
common organ of tactile sensation, are in anywise antagonistic 
to the idea of neuralgic isolation ; in the same manner as the 
union in the face of several nervous filaments endowed with differ- 
ent, nay, antithetic properties — for example, the centripede and 
centrifugal branches in one and the same fascia, without one 
branch participating of the function of the other — is not incon- 
sistent with medical observations. If, therefore, the three branch- 
es of the ♦ * * • are connected by an intimate bond, a 
similar connection exists between the branches composing the 
brachial, cervical, lumbar and plexus sacer, and the branches is- 
suing therefrom. Nevertheless, no matter with what degree of 



Memoir on Facial JVeuralgia. 891 

patience we nndertake to examine the yarious records of the 
neuralgias, quoted by different authors, we shall meet with mani^ 
fold examples of neuralgia confined to a single branch of the 
different plexus, or to a single ramification of the various nervous 
branches. It would be a task of too great magnitude for a paper 
of this kind to analyze them individually. I will therefore con- 
fine myself to the mention of a few facts. 

On the posterior and superior part of the neck, even if the 
slightest part of the skin be removed, we have immediately in 
view a plexus known under the designation of the posterior cer- 
vical, made up of the numberless anastomoses, formed by the 
posterior branches of the four leading cervical nerves. The en- 
tire portion of the vertebral column, comprised in the span of the 
first four vertebra, is taken up by nervous fillets of the first four 
pairs, which traversing the muscles proceed towards the * * 
• * * of the skin, where they spread out their superficial anas- 
tomotic branches. 

Among these branches is one belonging to the second pair, 
designated by Arnold as the great occipital nervCj which tra- 
versing the main complex muscle, after which it becomes sotto- 
cutaneous, and afterwards coming in contact with the occipital 
artery, runs upwards, and here branches off into a considerable 
variety of filaments, which in their divergency mask the occipital 
region. Such are the considerations which I have to offer touch- 
ing the posterior branches of the first four pair of cervical nerves, 
which on one side form a considerable number of nervous fillets 
constituting with their respective anastomoses an intricate net 
called the posterior cervical plexus ; and on the other an impor- 
tant ramification, which after having formed numerous points of 
union with the other branches, after becoming particularly sotto- 
cutaneous, proceeds at last to shoot out its peripheric extremities 
even to the * * * * and mastoideal apophyses. 

Now, it so happens that Berard, after having made numerous 
investigations, has illustrated a new neuralgia, which has its seat 
exclusively in the great occipital nerve ; and of this, some previ- 
ous writers had afforded a slight trace, so confused, however, as 
not to be productive of any benefit to the diagnostic art. In most 
cases, this neuralgy begins to circulate at the * * * from 
its anastomosis with the exterior frontal branch of the inferior 



392 Memoir on Facial JViuralgia. 

mascellar ; however, there are well accredited instances in which 
the neuralgia occarred only in the great occipital nerve without 
communicating itself to the * * * where the darting pain 
originating from a variable point between the mastoideal apopho- 
sis and the vertebral colon ascended to the occiput at a greater 
or less distance from the ear, radiating so far even as the parie- 
tal * * * ; thus following the course of the great occipital 
nerve and its branches. The name therefore given by Berard to 
this new neuralgia is inapplicable, to- wit: ^'Nouvelle espece de 
tic douloureux de face," while the designation given to it by Yal- 
leix is exact; namely, cervico- occipital neuralgia. And now 
coming to the brachial plexus, we must say, that although Yal- 
leix, in imitation of Berard, in consequence of the * * * 
nerve and the anatomical disposition, or, to speak more properly, 
in consequence of the numerous points of contact of the branches 
composing the brachial plexus, is inclined to consider this as a 
sole organ, and consequently pretends to advocate the sympathe- 
tic unity of the brachial neuralgia. The profound and admirable 
studies of Prof. Fillippo Tusana of Milan, completed in this year, 
have evidently proven the untenability of the neuralgic synthesis 
of the brachial plexus, and the gratuitous admission of this neu- 
ralgic unity, demonstrating that no such thing as a neuralgia of 
the brachial plexus exists ; but that there are as many neuralgic 
as there are fascic ramifications and branches composing the 
plexus of this name. Let our readers peruse this most excellent 
work, and they will find that Tusana has drawn this deduction 
from a most rigorous and minute analysis not only of his own 
observations but of those quoted by Valleix, in his chapter on 
Cervico -brachial Neuralgia. I will conclude by drawing the at- 
tention of our readers to the case of cubito- digital neuralgia, 
cited by Antonio Scarpa, wherein the pain, as in all cubital neu- 
ralgias, was not only limited to the mere course of the cubital 
nerve, but did not even extend through all its length, inasmuch 
as the darting pain originating in the palmar superfices of the 
* * * communicated itself downwards to the two last fingers. 
And as regards the ischiatic nerve, it also presents numerous 
anastomoses among the ramifications of its principal branches, 
and also affords numerous points of union with the crural nerve 
along the thigh and in the interior of the * * * with all the 



Memoir on Facial JSTeuralgia. 898 

nerves of this cavity ; so that the plexus sacer from its anatomical 
disposition and considered in regard to the neuralgia, may be re- 
garded as the interior portion of the ischiatic nerve. And this 
also presents neuralgia by no means rare or exceptional ; but, on 
the contrary, of frequent occurrence, and limited to certain 
points of its course. 

If we examine the data of this neuralgia, designated by Val- 
leix as the complex femoro^popliteal, we shall find that in some 
cases, the darting pain occupied the hip exclusively (Valleix Obs. 
48) ; in others, only the knee (Obs. 60) ; in others again, the 
ham, and occasionally only the outer side of the leg ; nor are there 
wanting instances in which the pain was confined to the foot. In 
the month of June of the present year, I excised the anterior tibial 
nerve of a Jewish girl to free her from a most virulent neuralgia 
to this ramification of the exterior popliteum. This case was re* 
markable for fierce * * * joined to the aflfection of the in- 
teroseal branch of the perronierum. Every remedy which the 
physicians applied to the uterine '* * * proved unavailing, 
while the "^ '*' * instantly disappeared on the excision of the 
tibial nerve. A curious fact this, and difficult to be accounted 
for, as it is perhaps only in the theory of reflex movements that 
we can look for its explanation. For the same reason as above, 
Valleix includes all those neuralgias which can invade the inter- 
costal and dorsal ramifications under the appellation of dorso- 
intercostal neuralgia, that is the slender bond which intervenes 
between the dorsal and intercostal branches of the twelve spino- 
dorsal pairs. ^' Si je ne distingue pas la nevralgie dorsale de la 
n^vralgie intercostale propriement dite, quoique j'aie observ6 des 
examples de ces aflfections entierement ind^pendantes I'une de 
I'autre, cdst que j'ai ^t^ guid6 par les m^mes motifs qui dans 
les n^vralgies pr6c6dentes m'ont fait rejeter les divisions trop 
restreintes." (Chap. 4me, p. 833.) 

To avoid digression, I will refrain from dwelling further on 
the anatomical distribution of the twelve dorsal pairs ; I shall 
only intimate that in spite of tho numerous anastomoses occur- 
ring among the intercostal branches with the thoracic branches 
deriving from the brachial plexus, with the nerves of the abdomi- 
nal parietes ; in spite of the frequent anastomoses of the dorsal 
branches with each other and with the lombo -abdominal ramifica- 



894 Memoir on Facial Neuralgia. 

tions, tbe history of the neuralgias under this name and daily 
experience, instead of rare and exceptional cases, aflford frequent 
instances in which the pain is confined at one time to the sixth, at 
another to the seventh, and again to the eighth intercostal space, 
sometimes to a circumscribed point of the spinous region of the 
yertebral • • * to the origin of the great psoas muscle and 
of the * * * of the loins, to the middle portion of the va- 
rious intercostal spaces ; and sometimes, in fine, to the point of 
union of the cartilages of the false ribs with the cartilage of the 
seventh rib, and of this latter with the sternum. Practitioners are 
now-a-days unanimous in regarding as a neuralgia of certain 
ramifications of the pneumogastricon, and even of its recurring 
nerve exclusively, that very troublesome and painful sensation, 
usually likened to a pill, which in hysteric females originates in 
the epigastrium, slowly ascends as far as the throat, and there 
determining at one time the aphony, at another the disfagia, pro- 
duces that spasm in the glottis which threatens to choke the pa- 
tient, and immediately precedes those great motions of flexion 
and extension of the trunk or limbs which characterize hysteric 
convulsion ; in a word, the hysteric * ♦ ♦ ^ designated by 
Prof. Beau under the name of aura gastroglottica, is nothing 
more than the neuralgia of the recurring nerve. (Traite esperi- 
mental clinique d'auscultation, p. 501. Revue des malad. a 
bruits artferiels.) 

But in order to prove the real existence of the partial neural- 
gias of the * * * we have not the least need of analogy ; 
while Valleix, himself, in his Twelve Observations, supplies us 
with a proportion which certainly exceeds the computation made 
by him ; namely, of 2 to 7. In fact, if we consider well, we shall 
find that the Observations 1st, 6th, 7th, and 10th, regard cases of 
simple frontal neuralgia. The 12th is a limited neuralgia, en- 
tirely limited to the superior mascellar nerve (Berard's), which 
we have frequently mentioned ; the 11th is an exclusive neuralgia 
of the inferior mascellar, and more especially of the inferior den- 
tary ; the 5th, if we preclude a slight indisposition scarce worthy 
of notice in the dentary arches and occiput,* may justly be said to 
be merely restricted to the ophthalmic branch ; the 4th, having 
its origin in the ophthalmic branch, radiates even at its commence- 
ment to the superior mascellar ; while it is only in the 2d, 8d and 



Memoir on Facial J^exiralgia. 895 

9tb, that the three branches are attacked. Even if every other 
proof were wanting, our case alone would furnish an incontesta- 
ble instance of a neuralgia, not only limited to a single branch 
of the * * * , but what is more, only to some single rami- 
fications of a sole branch ; namely, to the cutaneous branches of 
the superior masccUar nerve. It is true, that, at the close of the 
fifth year, the pain communicated itself also to the ophthalmic 
branch. This expansion, occurring after the neuralgia for the 
lapse of four years and a half, was constantly confined to the 
sub-orbital nerve, is no objection why we should not retain it as 
proper exclusively to the sub -orbital nerve. This consociation of 
sufferance of the 1st branch should, with good reason, bo regard- 
ed as a precarious and merely sympathetic sensation, attributable 
to the virulence of the pain resident in the sub- orbital branch, 
especially in the nasal point, designated by the anastomosis of 
the naso-palpebral nerve with the interior frontal ; let it then be 
considered — Istly, That the pain in the ophthalmic branch dis- 
appeared on the incision of the entire sub- orbital nerve, all the 
ramifications of the frontal remaining intact ; 2dly, That no fix- 
ed painful point was detected by means of pressure along the 
course of the frontal nerve ; 3dly, That the pain never awakened 
recently either spontaneously or artificially in the sopra-orbital 
foramen or any other point along the course of the frontal nerve; 
4thly, That the pain consequent on the operation never again 
appeared on the ramifications of the frontal nerve; 5thly, That 
this participation happened after four years and a half, when the 
pain in the sub- orbital nerve was at its highest ; so that had the 
excision of the sub- orbital nerve been performed three or four 
months before, there should have been no painful sensation of the 
ophthalmic branch ; 6th1y, That when the ophthalmic branch is 
attacked idiomatically by the neuralgia together with the mas- 
cellar branch, the pain arises in the former generally at or not 
long after its appearance in the latter ; nor is the excision of the 
sub- orbital nerve of any avail in dissipating the accompanying 
frontal neuralgia which still continues, because it is influenced by 
an alteration peculiar to the nervous pulp and of the neurilema, 
or proper and permanent want of equilibrium in the nervous 
fluid, whatever it may be ; 7th and lastly. That it is natural for 
every neuralgia, however limited, to radiate after several years' 



396 Memoir on Facial JSTenralgia. 

duration to the neighboring nerves, whether this may happen 
from a law of reflex motion or on account of the simple reason of 
anastomatic conjunctions. This case of ours, uUimatelj so se- 
vere, of neuralgia of the sub-orbital nerve, affords a marked ex- 
ception to another sentence found in Valleix, to-wit: " Les cas 
de n6vra1gie born6e a une seule branche sont ordinairement Ugers 
et ne durentque peu de jours," (page 51;) for we had to treat 
with a neuralgia limited to a few ramifications of the * * * 
* * , which of itself was extremely violent, and lasted five 
years ; the virulence of the pain continually increasing. 

After what we have adduced, the proposition also of Scarpa 
appears to us very untenable, nor do I find it sanctioned by ex- 
perience. And, indeed, even precluding the arguments adduced, 
is it not a capricious hypothesis, an arbitrary decision, to regard 
the neuralgias as diffused through the whole nerve, even when the 
pain manifests itself only in a few ramifications? On what data 
can we arrive at this diagnosis ? On the nature perhaps of the 
morbose causes? By this standard nothing positive or certain 
can be obtained. For if the etiological standard be of little aid 
(not to say that it generally leads even to error) in the diagnosis 
of the greater part of human maladies, we would venture any 
sum that it becomes all bat useless in regard to the genesis of 
neuralgia. From the symptoms perhaps ? The only symptom of 
neuralgia is the pain ; and this in many cases is limited to a part of 
a given nerve or to some of its ramifications. Perhaps from the 
remedies applied. 

We have here again the uncertainty and obscurity of the eti- 
ological standard. We know nothing positive of their mode of 
acting or extension of their action ; we only know that frequently 
the topical remedies avail in dispelling the pain limited to certain 
points of a given nerve, without being assured whether the medi- 
camentose action has been completely local, or has extended to 
the whole nerve. From the autopsies ? Few in number, and by 
no means conclusive, even these similar to the causes and reme- 
dies yield no assistance. 

'^L'anatomie Pathologique (says Gruveilhier justly) des nerfs 
est a faire." Hence we. do not hesitate to denounce the proposi- 
tion of Scarpa as arbitrary and hypothetical, and wanting the 



Memoir on Facial Neuralgia. 897 

principal support — namely, a correspondence with facts, with ob- 
servation, and with daily experience. 

While this case of which we speak corroborates more than ever 
the theory of Bell, of Berard, and of Miieller, which ascribes 
facial neuralgia altogether to the branches of the * * * * 
exclusive of the facial, it does not at the same time carry out the 
opinion of . Antonio Scarpa, who solemnly prohibits any surgical 
operation whatever in the essential neuralgias, that is, in those 
not produced by neuromi, * * * *, or tumors of any kind 
compressing the various nervous branches, by extraneous bodies 
at a great depth ; in which ( to use his own words ) the morbific 
ferment is not limited to the centre whence the painful radia- 
tions issue. This opinion is akin to that already mentioned ; 
namely, that in neuralgias, (except those depending on irritating 
local causes, as * * * neuromi, tumor, extraneous bodies, 
etc.,) in which no irritating local cause is detected, the pain does 
not totally manifest the seat of the complaint which propagates 
itself even to the root of the nerve, but the point in which the 
affected nerve is nearer than elsewhere to the surface of the body. 

There is no doubt but that in some neuralgias, occasioned by 
the general disorder of the nervous currents, the general morbid 
condition of the nervous apparatus, or by complaints of the great 
nervous centre, or by bodies compressing the cercbro- spinal sub- 
stance in the neighborhood of the origin of the nerve, (as, for 
instance, exostoses, fungi of the dura mater, or of the bones of 
the cranium,) the neuralgic pain communicates itself to the whole 
nerve ; however, there are various cases in which none of these 
causes exist ; no tubercle, no * * ''^ on the more superficial 
parts of the nerve ; and yet the pain is really confined to certain 
branches, to certain ramifications of the nerve, with regard to 
which the operation is therefore successful. However difficult it' 
may be to give a plausible explanation thereof at this time, espe- 
cially when the zoo-electric theories are so much in vogue for the 
explanation of the nervous functions, and consequently of their 
functional disorders which constitute their morbid condition ; the 
rigorous observation of facts— among the first of which we rank 
our case, and the two observations of Berard, in which there is no 
mention of an alteration in the nervous tissue or in the neuri^ema — 
authorize the surgical operation ; provided, however, they be not 



898 Memoir on Facial JVlsurafgia. 

accompanied witli those conditions which we have said should 

* * * all manipulation of any kind. Even here, to regard 
as extended to the whole nervous branch those neuralgias in 
which no irritating local cause is apparent, and the pain never- 
theless is confined to cutaneous ramifications and to certain 
branches of the nerve, would bo to explain a phenomenon 

* ♦ * * with a purely capricious hypothesis. In the pro- 
found obscurity which hangs over the physiological laws of the 
nervous system, and consequently over the etiology and palo- 
genia of nervous diseases in general, and especially of the essen- 
tial neuralgias, as no perceptible alteration of structure, no mor- 
bidness is generally detected along the whole length of the nerve 
attacked by neuralgia, I think we should refrain from all ex- 
planation, and adhere instead to the only one as yet, namely, 
simple observation. 

In perusing the account of Cornia's complaint, the reader must 
have observed, that during the phenomenological syndrome, w